Healthcare Provider Details

I. General information

NPI: 1881189769
Provider Name (Legal Business Name): LAURA VERONICA KAZUKENUS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 06/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MAIN ST
PEEKSKILL NY
10566-2907
US

IV. Provider business mailing address

36 CARTWHEEL DR
SCOTIA NY
12302-3028
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 518-669-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237974
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: