MEDICARE: MISS ERMIRA OLLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	I063762	NY

General Provider Information

NPI Number	:	1548819097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERMIRA OLLI

Provider Business Mailing Address
First Line	:	11011 72ND AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4910
Country	:	US
Telephone Number	:	646-527-3596
Fax Number	:

Provider Business Practice Location Address
First Line	:	2170 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-1149
Country	:	US
Telephone Number	:	212-666-3013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2019
Last Update Date	:	09/07/2019

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Directions to “ MISS ERMIRA OLLI ” Practice Location

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