Provider Demographics
NPI:1295089324
Name:JOSEPH, PRINCE (PHARMD)
Entity type:Individual
Prefix:
First Name:PRINCE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273A CONGERS RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6316
Mailing Address - Country:US
Mailing Address - Phone:845-507-3043
Mailing Address - Fax:
Practice Address - Street 1:273A CONGERS ROAD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6316
Practice Address - Country:US
Practice Address - Phone:845-507-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist