Provider Demographics
NPI:1306086699
Name:REISS, BLANCHE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:BLANCHE
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:BLANCHE
Other - Middle Name:
Other - Last Name:FRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6 WOODCREST RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1028
Mailing Address - Country:US
Mailing Address - Phone:845-354-0473
Mailing Address - Fax:845-354-0472
Practice Address - Street 1:6 WOODCREST RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1028
Practice Address - Country:US
Practice Address - Phone:845-354-0473
Practice Address - Fax:845-354-0472
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050638183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric