Provider Demographics
NPI:1184002511
Name:YOUSEFZADEH, NINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:YOUSEFZADEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JUNARD DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2014
Mailing Address - Country:US
Mailing Address - Phone:516-428-4005
Mailing Address - Fax:
Practice Address - Street 1:6 JUNARD DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2014
Practice Address - Country:US
Practice Address - Phone:516-428-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0484131835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric