Healthcare Provider Details

I. General information

NPI: 1306513890
Provider Name (Legal Business Name): LESLIE NJOKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date: 01/20/2022
Reactivation Date: 06/12/2023

III. Provider practice location address

2417 3RD AVE
BRONX NY
10451-6331
US

IV. Provider business mailing address

2417 3RD AVE
BRONX NY
10451-6331
US

V. Phone/Fax

Practice location:
  • Phone: 347-913-4656
  • Fax:
Mailing address:
  • Phone: 347-913-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI0066158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: