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Organization
TARGET
Active
Organization
TARGET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE TAYLOR-DOMVILLE JR. (PHARMACIST)
(201) 450-3990
Entity
Organization
Contact information
Practice address
500 W SUNRISE HWY, VALLEY STREAM, NY 11581-1001
(516) 568-9275
Mailing address
500 W SUNRISE HWY, VALLEY STREAM, NY 11581-1001
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
061081
NY
Other
Enumeration date
09/04/2015
Last updated
09/04/2015
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