Provider Demographics
NPI:1912155797
Name:GADELRAB, NISSREN (RPH)
Entity Type:Individual
Prefix:
First Name:NISSREN
Middle Name:
Last Name:GADELRAB
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 1:8831 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7736
Mailing Address - Country:US
Mailing Address - Phone:718-561-7400
Mailing Address - Fax:718-651-1777
Practice Address - Street 1:8831 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7736
Practice Address - Country:US
Practice Address - Phone:718-561-7400
Practice Address - Fax:718-651-1777
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist