Provider Demographics
NPI:1053308619
Name:BUONAIUTO, MADALENE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MADALENE
Middle Name:
Last Name:BUONAIUTO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15036 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3608
Mailing Address - Country:US
Mailing Address - Phone:718-461-4145
Mailing Address - Fax:718-828-7491
Practice Address - Street 1:2941 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4534
Practice Address - Country:US
Practice Address - Phone:718-828-0498
Practice Address - Fax:718-828-7491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist