Healthcare Provider Details

I. General information

NPI: 1952694390
Provider Name (Legal Business Name): SOPHIE MEZYNSKA RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 LEONARD ST
BROOKLYN NY
11222-3098
US

IV. Provider business mailing address

566 LEONARD ST
BROOKLYN NY
11222-3098
US

V. Phone/Fax

Practice location:
  • Phone: 718-389-1500
  • Fax: 718-389-1729
Mailing address:
  • Phone: 718-389-1500
  • Fax: 718-389-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: