Healthcare Provider Details

I. General information

NPI: 1639555808
Provider Name (Legal Business Name): YOUSSRA DWEDAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 6TH AVE
NEW YORK NY
10011-8422
US

IV. Provider business mailing address

475 6TH AVE
NEW YORK NY
10011-8422
US

V. Phone/Fax

Practice location:
  • Phone: 212-337-3242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: