Healthcare Provider Details

I. General information

NPI: 1952075319
Provider Name (Legal Business Name): HANNA LEGESSE YIGZAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1961 SOUTHERN BLVD
BRONX NY
10460-1419
US

IV. Provider business mailing address

601 W 190TH ST APT 21
NEW YORK NY
10040-3247
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-0299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04071600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number067404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: