Healthcare Provider Details

I. General information

NPI: 1588578058
Provider Name (Legal Business Name): STEFY KURIAKOSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21220 NORTHERN BLVD
BAYSIDE NY
11361-3342
US

IV. Provider business mailing address

21220 NORTHERN BLVD
BAYSIDE NY
11361-3342
US

V. Phone/Fax

Practice location:
  • Phone: 718-281-3223
  • Fax:
Mailing address:
  • Phone: 718-281-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074616
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: