Provider Demographics
NPI:1316269517
Name:PADELA, PARWEEN ILYAS (BPHARM)
Entity type:Individual
Prefix:MRS
First Name:PARWEEN
Middle Name:ILYAS
Last Name:PADELA
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 EASTON ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6615
Mailing Address - Country:US
Mailing Address - Phone:631-981-9688
Mailing Address - Fax:
Practice Address - Street 1:765 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2111
Practice Address - Country:US
Practice Address - Phone:631-369-9028
Practice Address - Fax:631-369-9066
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist