Healthcare Provider Details

I. General information

NPI: 1407463318
Provider Name (Legal Business Name): LORI OHANESIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI NISANYAN PHARMD

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1496
US

IV. Provider business mailing address

26228 59TH AVE
LITTLE NECK NY
11362-2501
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7430
  • Fax:
Mailing address:
  • Phone: 917-626-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number055871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: