Provider Demographics
NPI:1851623011
Name:HELENEK, MARY JANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:
Last Name:HELENEK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LUITPOLD DR
Mailing Address - Street 2:PO BOX 9001
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4709
Mailing Address - Country:US
Mailing Address - Phone:631-205-2101
Mailing Address - Fax:631-924-8650
Practice Address - Street 1:1 LUITPOLD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4709
Practice Address - Country:US
Practice Address - Phone:631-205-2101
Practice Address - Fax:631-924-8650
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist