Provider Demographics
NPI:1538337571
Name:FITZGERALD, JAMES FRANCIS (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FRANCIS
Last Name:FITZGERALD
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 1:15 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3337
Mailing Address - Country:US
Mailing Address - Phone:516-867-2011
Mailing Address - Fax:
Practice Address - Street 1:4055 MERRICK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2830
Practice Address - Country:US
Practice Address - Phone:516-826-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033764OtherNY PHARMACIST LICENSE