Basic Information
| Provider Information | |||||||||
| NPI: | 1003139924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROENCA | ||||||||
| FirstName: | VITOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3164 21ST ST | ||||||||
| Address2: | MERLIN CHEMISTS, INC | ||||||||
| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111064573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182678900 | ||||||||
| FaxNumber: | 7172678912 | ||||||||
| Practice Location | |||||||||
| Address1: | 3164 21ST ST | ||||||||
| Address2: | MERLIN CHEMISTS, INC | ||||||||
| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111064573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182678900 | ||||||||
| FaxNumber: | 7172678912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2010 | ||||||||
| LastUpdateDate: | 03/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 041927 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.