Provider Demographics
NPI:1720367360
Name:ANBALAGAN, RANGASAMY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANGASAMY
Middle Name:
Last Name:ANBALAGAN
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 1:54 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3229
Mailing Address - Country:US
Mailing Address - Phone:516-294-9254
Mailing Address - Fax:
Practice Address - Street 1:54 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3229
Practice Address - Country:US
Practice Address - Phone:516-294-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist