Provider Demographics
NPI:1255837365
Name:PANICKER, JUBY JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUBY
Middle Name:JOHN
Last Name:PANICKER
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 1:461 N GANNON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4317
Mailing Address - Country:US
Mailing Address - Phone:347-452-1970
Mailing Address - Fax:
Practice Address - Street 1:461 N GANNON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4317
Practice Address - Country:US
Practice Address - Phone:347-452-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist