Provider Demographics
NPI:1992199327
Name:SEGAL, PENINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:PENINA
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14747 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2543
Mailing Address - Country:US
Mailing Address - Phone:718-909-5027
Mailing Address - Fax:
Practice Address - Street 1:239 E 198TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3147
Practice Address - Country:US
Practice Address - Phone:718-933-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059635I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist