Provider Demographics
NPI:1821202706
Name:BIFULCO, SALVATORE (RPH)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:BIFULCO
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 1:34 ASTOR PL
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1013
Mailing Address - Country:US
Mailing Address - Phone:845-354-3965
Mailing Address - Fax:
Practice Address - Street 1:63 ORANGE TPKE
Practice Address - Street 2:
Practice Address - City:SLOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10974-2319
Practice Address - Country:US
Practice Address - Phone:845-753-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist