Healthcare Provider Details

I. General information

NPI: 1750358842
Provider Name (Legal Business Name): MICHELE MARIE CERNY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE MARIE JAKUBOWSKI PHARM.D.

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 MAIN ST
HOLBROOK NY
11741-1606
US

IV. Provider business mailing address

26 BOKEL RD
RONKONKOMA NY
11779-6707
US

V. Phone/Fax

Practice location:
  • Phone: 631-585-8585
  • Fax:
Mailing address:
  • Phone: 631-901-4887
  • Fax: 631-585-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: