Provider Demographics
NPI:1114408721
Name:CHOWDHARY, JYOTIKA
Entity Type:Individual
Prefix:
First Name:JYOTIKA
Middle Name:
Last Name:CHOWDHARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GARDENIA LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2009
Mailing Address - Country:US
Mailing Address - Phone:347-237-6939
Mailing Address - Fax:
Practice Address - Street 1:399 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5501
Practice Address - Country:US
Practice Address - Phone:516-935-0126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist