Healthcare Provider Details

I. General information

NPI: 1720740087
Provider Name (Legal Business Name): NICOLE YIOUPIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CROSSWAYS PARK DR
WOODBURY NY
11797-2066
US

IV. Provider business mailing address

333 CROSSWAYS PARK DR
WOODBURY NY
11797-2066
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-3850
  • Fax: 866-626-7525
Mailing address:
  • Phone: 631-321-3850
  • Fax: 866-626-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number068402
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: