Provider Demographics
NPI:1023619186
Name:CRILLEY, SETA (RPH)
Entity type:Individual
Prefix:
First Name:SETA
Middle Name:
Last Name:CRILLEY
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 1:17 FISHERMANS DR
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1733
Mailing Address - Country:US
Mailing Address - Phone:516-376-7273
Mailing Address - Fax:
Practice Address - Street 1:17 FISHERMANS DR
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1733
Practice Address - Country:US
Practice Address - Phone:516-376-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045565-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist