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General NPI Number Information
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NPI Number | 1063735462
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Entity Type | Individual
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Provider Name | MARIYA RACKMAN PHARM D
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Gender | Female
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Dates
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Enumeration Date | 03/12/2010
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 19718 HILLSIDE AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2127
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Country | US
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Telephone | 718-464-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 18804 64TH AVE APT 11D
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3892
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Country | US
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Telephone | 718-454-5028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 052782
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA-18365
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License Number State | CO
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