Provider Demographics
NPI:1407922206
Name:FISHMAN, JULIA Y (MPA RPH)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:Y
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:MPA RPH
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:Y
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPA RPH
Mailing Address - Street 1:1611 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6947
Mailing Address - Country:US
Mailing Address - Phone:917-771-7585
Mailing Address - Fax:
Practice Address - Street 1:1611 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6947
Practice Address - Country:US
Practice Address - Phone:917-771-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist