Provider Demographics
NPI:1700493624
Name:MAVRIQI, LORENA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:
Last Name:MAVRIQI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:ALIMERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6120 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3304
Mailing Address - Country:US
Mailing Address - Phone:929-313-0626
Mailing Address - Fax:
Practice Address - Street 1:6120 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3304
Practice Address - Country:US
Practice Address - Phone:929-313-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist