Provider Demographics
NPI:1922321702
Name:STAN, MARITZA TARANCON (RPH)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:TARANCON
Last Name:STAN
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 1:1807 CASPER AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1621
Mailing Address - Country:US
Mailing Address - Phone:516-640-5000
Mailing Address - Fax:
Practice Address - Street 1:3491 MERRICK RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4331
Practice Address - Country:US
Practice Address - Phone:516-679-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist