| Doctor Name: | MR. MARK A GOTTLIEB |
| NPI Number: | 1932421757 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPH |
| License Number: | 025255 |
| Business Practice Address: | 11 Mulberry Dr Tuxedo Park, NY - 109874814 |
| Business Phone Number: | 8457536031 |
| Business Fax Number: | |
| Mailing Address: | 11 Mulberry Dr, TUXEDO PARK |
| State: | NY |
| Postal Code: | 109874814 |
| Phone Number: | 8457536031 |
| Fax Number: | |
| NPI Enumeration Date: | 02/20/2010 |
| NPI Last Update Date: | 02/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835G0303X |
| License Number: | 025255 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Geriatric |
| Taxonomy Definition: | A pharmacist who is certified in geriatric pharmacy practice is designated as a |