Provider Demographics
NPI:1760479067
Name:RATTINER, ALAN ROBERT (BS PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
Last Name:RATTINER
Suffix:
Gender:M
Credentials:BS PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18512 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4860
Mailing Address - Country:US
Mailing Address - Phone:718-526-1121
Mailing Address - Fax:718-526-1272
Practice Address - Street 1:18512 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4860
Practice Address - Country:US
Practice Address - Phone:718-526-1121
Practice Address - Fax:718-526-1272
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25623OtherPHARMACIST LICENSE