Individual
LYSAMMA KURUVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACYTECH
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-2430
Mailing address
177 AVERILL BLVD, FRANKLIN SQUARE, NY 11010-1601
(718) 290-5401
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
000401
NY
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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