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General NPI Number Information
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NPI Number | 1831801893
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Entity Type | Individual
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Provider Name | LYSAMMA KURUVILA PHARMACYTECH
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Gender | Female
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Dates
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Enumeration Date | 12/21/2022
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 7901 BROADWAY
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City | ELMHURST
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State | NY
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Zip | 11373-1329
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Country | US
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Telephone | 718-334-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 177 AVERILL BLVD
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-1601
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Country | US
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Telephone | 718-290-5401
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 000401
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License Number State | NY
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