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NPI Code Detail

MEDICARE: JIRANAREE LOSIRISUP

MEDICARE: JIRANAREE LOSIRISUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist054212NY

General Provider Information

NPI Number : 1073835344
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIRANAREE LOSIRISUP
Provider Business Mailing Address
First Line : 758 ARTHUR KILL RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-2141
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 758 ARTHUR KILL RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-2141
Country : US
Telephone Number : 718-317-5085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2010
Last Update Date : 02/26/2010

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Directions to “ JIRANAREE LOSIRISUP ” Practice Location

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