Provider Demographics
NPI:1144531427
Name:MENDELSOHN, STEPHEN (PHARMACIST (RPH))
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:PHARMACIST (RPH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4277 HEMPSTEAD TPKE
Mailing Address - Street 2:BETHPAGE MEDICAL PHARMACY
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-796-4004
Mailing Address - Fax:516-520-3033
Practice Address - Street 1:4277 HEMPSTEAD TPKE.
Practice Address - Street 2:BETHPAGE MEDICAL PHARMACY
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-796-4004
Practice Address - Fax:516-520-3033
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist