Provider Demographics
NPI:1912185190
Name:GILBERT, MAX (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAX
Middle Name:
Last Name:GILBERT
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 1:63 THADFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4940
Mailing Address - Country:US
Mailing Address - Phone:631-368-0276
Mailing Address - Fax:631-368-3980
Practice Address - Street 1:2162 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3503
Practice Address - Country:US
Practice Address - Phone:631-444-0968
Practice Address - Fax:631-444-0963
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist