Individual
LARINA BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
234 E 149TH ST, BRONX, NY 10451-5589
(718) 579-6536
Mailing address
234 E 149TH ST FL 5C, RM 168, BRONX, NY 10451-5589
(718) 579-6536
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
CI067485
NY
1835P2201X
Ambulatory Care Pharmacist
I067485
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2019
Last updated
11/18/2021
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