Healthcare Provider Details

I. General information

NPI: 1679812770
Provider Name (Legal Business Name): ZANA BLAKU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

687 BRONX RIVER ROAD 7G
YONKERS NY
10704
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4103
  • Fax:
Mailing address:
  • Phone: 917-620-6581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053224
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number053224
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number053224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: