Healthcare Provider Details

I. General information

NPI: 1598121147
Provider Name (Legal Business Name): JACQUELINE YOCHEVED GEWIRTZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WALT WHITMAN RD
MELVILLE NY
11747-3282
US

IV. Provider business mailing address

1860 WALT WHITMAN RD
MELVILLE NY
11747-3672
US

V. Phone/Fax

Practice location:
  • Phone: 855-821-6300
  • Fax:
Mailing address:
  • Phone: 855-821-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: