Provider Demographics
NPI:1316244577
Name:NIEBUHR, CAROLYN ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:NIEBUHR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MONTAUK HWY UNIT A
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1156
Mailing Address - Country:US
Mailing Address - Phone:631-874-3784
Mailing Address - Fax:631-874-3799
Practice Address - Street 1:94 MONTAUK HWY UNIT A
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1156
Practice Address - Country:US
Practice Address - Phone:631-874-3784
Practice Address - Fax:631-874-3799
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist