Provider Demographics
NPI:1255512240
Name:ENGVALDSEN, TINA (RPH)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:ENGVALDSEN
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 1:226 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2853
Mailing Address - Country:US
Mailing Address - Phone:631-751-8100
Mailing Address - Fax:
Practice Address - Street 1:226 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2853
Practice Address - Country:US
Practice Address - Phone:631-751-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-18
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist