Provider Demographics
NPI:1376725473
Name:DAVIDI, STELLA (RPH)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:DAVIDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BROADWAY (AT PARK PLACE)
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007
Mailing Address - Country:US
Mailing Address - Phone:212-571-4511
Mailing Address - Fax:212-571-4515
Practice Address - Street 1:250 BROADWAY (AT PARK PLACE)
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007
Practice Address - Country:US
Practice Address - Phone:212-571-4511
Practice Address - Fax:212-571-4515
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01562394Medicaid