Healthcare Provider Details

I. General information

NPI: 1992029383
Provider Name (Legal Business Name): JACQUELINE HANAN GABBAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

V. Phone/Fax

Practice location:
  • Phone: 728-363-6568
  • Fax:
Mailing address:
  • Phone: 718-363-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number20054235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: