Provider Demographics
NPI:1396069548
Name:LOMBARDO, SALVATORE JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:JOSEPH
Last Name:LOMBARDO
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 1:10607 CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2906
Mailing Address - Country:US
Mailing Address - Phone:718-699-5099
Mailing Address - Fax:
Practice Address - Street 1:10607 CORONA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2906
Practice Address - Country:US
Practice Address - Phone:718-699-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00340652Medicaid