Provider Demographics
NPI:1114305299
Name:ARDOLIC, HANIFE (PHARMD)
Entity type:Individual
Prefix:
First Name:HANIFE
Middle Name:
Last Name:ARDOLIC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4515
Mailing Address - Country:US
Mailing Address - Phone:718-300-3581
Mailing Address - Fax:
Practice Address - Street 1:133 BEACON LN
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1983
Practice Address - Country:US
Practice Address - Phone:718-300-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist