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General NPI Number Information
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NPI Number | 1710694625
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Entity Type | Individual
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Provider Name | CHARLENE JAYNE BLAND PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 122 W 146TH ST
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City | NEW YORK
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State | NY
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Zip | 10039-3802
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Country | US
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Telephone | 212-675-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 1139 PROSPECT AVE APT 2F
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City | BROOKLYN
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State | NY
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Zip | 11218-1139
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Country | US
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Telephone | 626-200-8200
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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 | I069512
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License Number State | NY
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