Healthcare Provider Details

I. General information

NPI: 1912340688
Provider Name (Legal Business Name): LUDOVICK YOUMBI PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 12/31/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4377 BRONX BLVD
BRONX NY
10466-1397
US

IV. Provider business mailing address

4377 BRONX BLVD
BRONX NY
10466-1397
US

V. Phone/Fax

Practice location:
  • Phone: 866-293-1559
  • Fax: 888-828-6230
Mailing address:
  • Phone: 202-290-9317
  • Fax: 888-828-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number057807
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: