Basic Information
Provider Information
NPI: 1003139544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOX
FirstName: MICHAEL
MiddleName: ARNOLD
NamePrefix: MR.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3948 RICHMOND AVE
Address2:  
City: STATEN ISLAND
State: NY
PostalCode: 103125111
CountryCode: US
TelephoneNumber: 7183561789
FaxNumber: 7183561777
Practice Location
Address1: 3948 RICHMOND AVE
Address2:  
City: STATEN ISLAND
State: NY
PostalCode: 103125111
CountryCode: US
TelephoneNumber: 7183561789
FaxNumber: 7183561777
Other Information
ProviderEnumerationDate: 03/11/2010
LastUpdateDate: 03/11/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X028145NYY Pharmacy Service ProvidersPharmacist 
1835P0018X028145NYN Pharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

No ID Information.


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