Individual
TY JACOB STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
462 1ST AVE, NEW YORK, NY 10016
(212) 562-4141
Mailing address
462 1ST AVE, NEW YORK, NY 10016-9196
(212) 562-4141
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
064981
NY
Other
Enumeration date
09/16/2019
Last updated
11/07/2019
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