Provider Demographics
NPI:1336471564
Name:PATZELT-GUERRA, JOAN PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:PATRICIA
Last Name:PATZELT-GUERRA
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 1:16312 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3339
Mailing Address - Country:US
Mailing Address - Phone:718-352-8732
Mailing Address - Fax:
Practice Address - Street 1:2021 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3930
Practice Address - Country:US
Practice Address - Phone:718-225-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037530-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist