Individual
DEA AGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
465 2ND AVE, NEW YORK, NY 10016-9106
(917) 326-9030
Mailing address
465 2ND AVE, NEW YORK, NY 10016-9106
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
069887
NY
Other
Enumeration date
11/16/2022
Last updated
02/10/2024
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