Provider Demographics
NPI:1710292693
Name:MONAHAN, JUSTINE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:MARIE
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JUSTINE
Other - Middle Name:MARIE
Other - Last Name:BIANCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6150 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3810
Mailing Address - Country:US
Mailing Address - Phone:716-515-3305
Mailing Address - Fax:855-331-9037
Practice Address - Street 1:6150 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3810
Practice Address - Country:US
Practice Address - Phone:716-515-3305
Practice Address - Fax:855-331-9037
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist