Provider Demographics
NPI:1558684308
Name:TABOUCHIRANI, CHARLES (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:TABOUCHIRANI
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 85TH ST
Mailing Address - Street 2:APT 12H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7405
Mailing Address - Country:US
Mailing Address - Phone:212-717-7797
Mailing Address - Fax:212-717-7566
Practice Address - Street 1:207 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6453
Practice Address - Country:US
Practice Address - Phone:212-717-7797
Practice Address - Fax:212-717-7566
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046051OtherNY STATE LICENSE NUMBER