NPIMap

Anika Raisa

Individual provider Active NPI Pharmacist · Freeport, NY

NPI 1164848461 · NPPES record last updated May 17, 2018

Key facts

NPI
1164848461
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
058989 (NY)
Practice address
89 Henry St
Freeport, NY 11520
Phone
(516) 623-9719
NPI assigned
Mar 11, 2014
Sex
Female
Sole proprietor
No

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
058989NYMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Eastern Co Inc Past Accepting new patients
Walgreen Eastern Co Inc Past Accepting new patients
Walgreen Co Past
since Mar 6, 2022		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 058989 NY Yes

Addresses

Primary practice location

89 Henry St
Freeport, NY 11520

Mailing address

89 Henry St
Freeport, NY 11520-3906
Phone (516) 623-9719

Other practice location 1

652 Hempstead Tpke
Franklin Square, NY 11010-4326
Phone (516) 486-1485

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 17, 2018.

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1164848461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 HENRY ST",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115203906",
            "telephone_number": "516-623-9719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 HENRY ST",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "11520",
            "telephone_number": "516-623-9719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "652 Hempstead Tpke",
            "address_purpose": "LOCATION",
            "city": "Franklin Square",
            "state": "NY",
            "postal_code": "110104326",
            "country_code": "US",
            "telephone_number": "516-486-1485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAISA",
        "first_name": "ANIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-11",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "058989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, NY

All providers in Freeport, NY · Pharmacist in New York

Sources for this page

Verify at the official NPI Registry.