Provider Demographics
NPI:1376690545
Name:GERBAUCKAS, DIANA MARIE (RPH,MS)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:MARIE
Last Name:GERBAUCKAS
Suffix:
Gender:F
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 80TH ST
Mailing Address - Street 2:APT 6 H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0915
Mailing Address - Country:US
Mailing Address - Phone:212-988-7379
Mailing Address - Fax:
Practice Address - Street 1:1569 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4003
Practice Address - Country:US
Practice Address - Phone:212-249-5198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025194-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist