Healthcare Provider Details

I. General information

NPI: 1679942965
Provider Name (Legal Business Name): DE FA ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 COLLEGE POINT BLVD
COLLEGE POINT NY
11356-2210
US

IV. Provider business mailing address

1508 COLLEGE POINT BLVD
COLLEGE POINT NY
11356-2210
US

V. Phone/Fax

Practice location:
  • Phone: 718-445-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: