Albert L. Didonna
Individual provider Active NPI Pharmacist · Port Ewen, NY
NPI 1174840938 · NPPES record last updated May 3, 2010
Key facts
- NPI
- 1174840938
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 025469-1 (NY)
- Practice address
- 177 Broadway
Port Ewen, NY 12466 - Phone
- (845) 331-4229
- NPI assigned
- May 3, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025469-1 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Port Ewen Pharmacy Inc | Past | Accepting new patients | |
| Port Ewen RX Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 025469-1 | NY | Yes |
Addresses
Primary practice location
177 Broadway
Port Ewen, NY 12466
Mailing address
204 Windsor Dr
Hurley, NY 12443-5326
Phone (845) 331-9075
Other providers in Port Ewen, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.