Provider Demographics
NPI:1689906083
Name:MAYO, PETER W (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:MAYO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66-87 FRESH POND ROAD
Mailing Address - Street 2:MIL-RUE CHEMISTS, INC.
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3948
Mailing Address - Country:US
Mailing Address - Phone:718-821-3271
Mailing Address - Fax:718-386-9777
Practice Address - Street 1:66-87 FRESH POND ROAD
Practice Address - Street 2:MIL-RUE CHEMISTS, INC.
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3948
Practice Address - Country:US
Practice Address - Phone:718-821-3271
Practice Address - Fax:718-386-9777
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist