=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336386911
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. YOUSSEF FOUERTI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2009
-----------------------------------------------------
Last Update Date | 01/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1312 KINGS HWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-627-0800
-----------------------------------------------------
Fax | 718-627-5400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1312 KINGS HWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-627-0800
-----------------------------------------------------
Fax | 718-627-5400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 043187-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------