Provider Demographics
NPI:1124346291
Name:PANTINA, CHARLES J (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:PANTINA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14102 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1440
Mailing Address - Country:US
Mailing Address - Phone:718-374-3121
Mailing Address - Fax:718-674-6038
Practice Address - Street 1:14102 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11436-1440
Practice Address - Country:US
Practice Address - Phone:718-374-3121
Practice Address - Fax:718-674-6038
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist