Provider Demographics
NPI:1275306334
Name:CRISTOBAL, JOYCE ANNE DOMINGO (PHARMACIST (RPH))
Entity Type:Individual
Prefix:
First Name:JOYCE ANNE
Middle Name:DOMINGO
Last Name:CRISTOBAL
Suffix:
Gender:F
Credentials:PHARMACIST (RPH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CARPENTER AVENUE APT E-8
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-522-3305
Mailing Address - Fax:
Practice Address - Street 1:20 N SALEM ROAD (CROSS RIVER PHARMACY)
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518
Practice Address - Country:US
Practice Address - Phone:914-763-3152
Practice Address - Fax:914-763-6567
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist