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NPI Code Detail

MEDICARE: CONSUELO JUAREZ

MEDICARE:   CONSUELO  JUAREZ
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
1183500000XPharmacist033787NY

General Provider Information

NPI Number : 1558686881
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSUELO JUAREZ
Provider Business Mailing Address
First Line : 21819 93RD AVE
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11428-1838
Country : US
Telephone Number : 718-479-6615
Fax Number :
Provider Business Practice Location Address
First Line : 291 KNICKERBOCKER AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11237-3103
Country : US
Telephone Number : 718-456-5475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2010
Last Update Date : 03/30/2010

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Directions to “ CONSUELO JUAREZ ” Practice Location

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