Provider Demographics
NPI:1750864971
Name:PANSELINOS, MARTHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:PANSELINOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4811
Mailing Address - Country:US
Mailing Address - Phone:212-222-0966
Mailing Address - Fax:833-200-5596
Practice Address - Street 1:288 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4811
Practice Address - Country:US
Practice Address - Phone:212-222-0966
Practice Address - Fax:833-200-5596
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4511083336C0003X
VA02022153283336C0003X
NYI0639573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy