Provider Demographics
NPI:1154877314
Name:COLLANTES, CYRIL MANUEL C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CYRIL MANUEL
Middle Name:C
Last Name:COLLANTES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CYRIL
Other - Middle Name:C
Other - Last Name:COLLANTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-3001
Mailing Address - Country:US
Mailing Address - Phone:908-499-3435
Mailing Address - Fax:
Practice Address - Street 1:4707 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1629
Practice Address - Country:US
Practice Address - Phone:718-726-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist