Provider Demographics
NPI:1033820543
Name:JAKUBOVICS, MICHELLE LEAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEAH
Last Name:JAKUBOVICS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEAH
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1046 E 14TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4263
Mailing Address - Country:US
Mailing Address - Phone:917-589-0246
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:917-589-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0586511835P1200X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Multi-Specialty
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric