Provider Demographics
NPI:1063499036
Name:YOHANNES, NADIA (BPHARM)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:YOHANNES
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 YORK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5654
Mailing Address - Country:US
Mailing Address - Phone:203-688-7064
Mailing Address - Fax:203-688-9606
Practice Address - Street 1:50 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5654
Practice Address - Country:US
Practice Address - Phone:203-688-7064
Practice Address - Fax:203-688-9606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist