Healthcare Provider Details

I. General information

NPI: 1114100054
Provider Name (Legal Business Name): JACQUELINE ANN DONOGHUE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE ANN SZEWCZYK RPH

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 JAMAICA AVE
WOODHAVEN NY
11421-2040
US

IV. Provider business mailing address

8910 JAMAICA AVE
WOODHAVEN NY
11421-2040
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-7777
  • Fax: 718-849-9103
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046405-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 33293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: