=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821774746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BANAN DEYAB PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2023
-----------------------------------------------------
Last Update Date | 06/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7209 NORTHERN BOULEVARD
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-533-8434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8607 91ST AVENUE
-----------------------------------------------------
City | WOODHAVEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 070087
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------