Provider Demographics
NPI:1366622029
Name:PURDY, JOANNE T (RPH)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:T
Last Name:PURDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18914 CROCHERON AVE
Mailing Address - Street 2:APT # 602
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2311
Mailing Address - Country:US
Mailing Address - Phone:718-478-1168
Mailing Address - Fax:
Practice Address - Street 1:3732 82ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7032
Practice Address - Country:US
Practice Address - Phone:718-478-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00267643Medicaid