Provider Demographics
NPI:1790967479
Name:AUTORINO, DONNA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:AUTORINO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:MAGLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PARKDALE PHARMACY
Mailing Address - Street 2:945 ROSEDALE ROAD
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-791-6500
Mailing Address - Fax:516-791-6501
Practice Address - Street 1:945 ROSEDALE RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2318
Practice Address - Country:US
Practice Address - Phone:516-791-6500
Practice Address - Fax:516-791-6501
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist