Provider Demographics
NPI:1831915859
Name:VELASQUEZ, WILLBER ALEXANDER (RPH)
Entity type:Individual
Prefix:DR
First Name:WILLBER
Middle Name:ALEXANDER
Last Name:VELASQUEZ
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 1:1845 BROWNING ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2321
Mailing Address - Country:US
Mailing Address - Phone:516-315-9676
Mailing Address - Fax:
Practice Address - Street 1:5125 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3728
Practice Address - Country:US
Practice Address - Phone:516-798-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist