Healthcare Provider Details

I. General information

NPI: 1801233960
Provider Name (Legal Business Name): YACOB PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 SAINT JOHNS PL
BROOKLYN NY
11213-2699
US

IV. Provider business mailing address

1106 SAINT JOHNS PL
BROOKLYN NY
11213-2699
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-4805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ISMAIL MOHAMED
Title or Position: PRESIDENT
Credential:
Phone: 727-457-7539