Provider Demographics
NPI:1932423514
Name:GREENBERG, HOWARD (RPH)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:GREENBERG
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 1:8721 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3609
Mailing Address - Country:US
Mailing Address - Phone:718-257-2344
Mailing Address - Fax:718-257-2364
Practice Address - Street 1:8721 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3609
Practice Address - Country:US
Practice Address - Phone:718-257-2344
Practice Address - Fax:718-257-2364
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207243Medicaid
NY02207243Medicaid