Provider Demographics
NPI:1194542118
Name:LEVATINO, MARC THOMAS (RPH)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:THOMAS
Last Name:LEVATINO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GRASMERE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1565
Mailing Address - Country:US
Mailing Address - Phone:917-213-5110
Mailing Address - Fax:
Practice Address - Street 1:2110 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2576
Practice Address - Country:US
Practice Address - Phone:718-351-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist