Healthcare Provider Details

I. General information

NPI: 1689858409
Provider Name (Legal Business Name): ELLANA B. PINCHASOW PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 1ST AVE
NEW YORK NY
10029-6419
US

IV. Provider business mailing address

11040 JEWEL AVE
FOREST HILLS NY
11375-3958
US

V. Phone/Fax

Practice location:
  • Phone: 212-360-5530
  • Fax:
Mailing address:
  • Phone: 718-268-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0500661
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0500661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: