Healthcare Provider Details

I. General information

NPI: 1760706550
Provider Name (Legal Business Name): JAMILEH ZIBAK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 AVENUE M M DRUGS INC.
BROOKLYN NY
11230-4611
US

IV. Provider business mailing address

405 AVENUE M M DRUGS INC.
BROOKLYN NY
11230-4611
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-7334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: