Provider Demographics
NPI:1154359560
Name:MICHAELS, LARRY (BS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BERKELEY PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6401
Mailing Address - Country:US
Mailing Address - Phone:516-798-3956
Mailing Address - Fax:
Practice Address - Street 1:7035 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3049
Practice Address - Country:US
Practice Address - Phone:718-591-1040
Practice Address - Fax:718-591-4655
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025585OtherPHARMACIST LICENSE NUMBER