Healthcare Provider Details

I. General information

NPI: 1700653342
Provider Name (Legal Business Name): PARICHEHR SHOURESHI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 OLD COUNTRY RD
PLAINVIEW NY
11803-4905
US

IV. Provider business mailing address

104 SEARINGTOWN RD
ALBERTSON NY
11507-1124
US

V. Phone/Fax

Practice location:
  • Phone: 516-934-0095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number070447
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: