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General NPI Number Information
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NPI Number | 1881919991
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Entity Type | Individual
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Provider Name | MARK YERUSHALMI
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Gender | Male
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 656 NEW HAVEN AVE
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City | DERBY
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State | CT
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Zip | 06418-2528
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Country | US
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Telephone | 203-736-2667
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Fax |
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Provider Business Mailing Address
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Address Line | 656 NEW HAVEN AVE
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City | DERBY
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State | CT
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Zip | 06418-2528
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Country | US
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Telephone | 203-736-2667
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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 | 039043-1
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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 | 6827
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License Number State | CT
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