Healthcare Provider Details

I. General information

NPI: 1972819928
Provider Name (Legal Business Name): YULIANA TODERIKA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 EASTCHESTER RD
BRONX NY
10461-2604
US

IV. Provider business mailing address

1937 STILLWELL AVE
BROOKLYN NY
11223-2441
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8040
  • Fax:
Mailing address:
  • Phone: 718-415-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number054710
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: