Provider Demographics
NPI:1922282193
Name:DORIME, EDWIGE MARIE (RPH,)
Entity Type:Individual
Prefix:MRS
First Name:EDWIGE
Middle Name:MARIE
Last Name:DORIME
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 1:30 SARAH DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6322
Mailing Address - Country:US
Mailing Address - Phone:631-243-6976
Mailing Address - Fax:718-398-0122
Practice Address - Street 1:1200 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2022
Practice Address - Country:US
Practice Address - Phone:718-398-9000
Practice Address - Fax:718-398-0122
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01293865Medicaid