Provider Demographics
NPI:1275113862
Name:FLAKWAH, JAEL N (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:N
Last Name:FLAKWAH
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 1:202 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-6106
Mailing Address - Country:US
Mailing Address - Phone:845-694-9242
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:845-694-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04140000183500000X
CTPCT.0015481183500000X
NYI067632-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI067632-01OtherNYS PHARMACIST
CTPCT.0015481OtherCT
NJ28RI04140000OtherNJ