Provider Demographics
NPI:1902027980
Name:RESTREPO, CLARA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:
Last Name:RESTREPO
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 1:50 FULTON AVE STORE NO 1
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550
Mailing Address - Country:US
Mailing Address - Phone:516-539-2144
Mailing Address - Fax:718-359-9780
Practice Address - Street 1:50 FULTON AVE STORE NO.1
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-539-2144
Practice Address - Fax:718-359-9780
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044138183500000X
NY0282733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist