Provider Demographics
NPI:1003139924
Name:PROENCA, VITOR (RPH)
Entity type:Individual
Prefix:MR
First Name:VITOR
Middle Name:
Last Name:PROENCA
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 1:3164 21ST ST
Mailing Address - Street 2:MERLIN CHEMISTS, INC
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4573
Mailing Address - Country:US
Mailing Address - Phone:718-267-8900
Mailing Address - Fax:717-267-8912
Practice Address - Street 1:3164 21ST ST
Practice Address - Street 2:MERLIN CHEMISTS, INC
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4573
Practice Address - Country:US
Practice Address - Phone:718-267-8900
Practice Address - Fax:717-267-8912
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist