Provider Demographics
NPI:1871775916
Name:CONTE, RENATA M (RPH)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:M
Last Name:CONTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 JEFFERSON PLZ
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1104
Mailing Address - Country:US
Mailing Address - Phone:631-476-8334
Mailing Address - Fax:
Practice Address - Street 1:518 JEFFERSON PLZ
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1104
Practice Address - Country:US
Practice Address - Phone:631-476-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01869410Medicaid