Provider Demographics
NPI:1982888137
Name:ST FLEUR, PIERRE WINCHEL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:WINCHEL
Last Name:ST FLEUR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 BOWE RD W
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-612-2260
Mailing Address - Fax:718-367-4164
Practice Address - Street 1:1985 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BONX
Practice Address - State:NY
Practice Address - Zip Code:11045-2103
Practice Address - Country:US
Practice Address - Phone:718-716-6299
Practice Address - Fax:718-716-6298
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042595-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021196Medicaid