Provider Demographics
NPI:1184248056
Name:POMPA, MANFREDO (RPH)
Entity type:Individual
Prefix:
First Name:MANFREDO
Middle Name:
Last Name:POMPA
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 1:42 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7225
Mailing Address - Country:US
Mailing Address - Phone:914-420-2875
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PARKWAY
Practice Address - Street 2:PHARMACY DEPT BN24
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1046
Practice Address - Country:US
Practice Address - Phone:718-918-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123456Medicaid