Provider Demographics
NPI:1922390178
Name:ALDEBOT, WILFREDO A (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:A
Last Name:ALDEBOT
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 1:1412 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6941
Mailing Address - Country:US
Mailing Address - Phone:212-996-9499
Mailing Address - Fax:212-876-7782
Practice Address - Street 1:1412 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6941
Practice Address - Country:US
Practice Address - Phone:212-996-9499
Practice Address - Fax:212-876-7782
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist