Provider Demographics
NPI:1891019295
Name:MALIK, MARIANA MAGDELENA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:MAGDELENA
Last Name:MALIK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MARIANA
Other - Middle Name:MIURA
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1850 FRONT STREET
Mailing Address - Street 2:PRESCRIPTION HEADQUARTERS
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-222-0778
Mailing Address - Fax:516-222-0605
Practice Address - Street 1:1850 FRONT STREET
Practice Address - Street 2:PRESRIPTION HEADQUARTERS
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-222-0778
Practice Address - Fax:516-222-0605
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist