Provider Demographics
NPI:1710552062
Name:PALACKAL, JUBY TONY
Entity Type:Individual
Prefix:MRS
First Name:JUBY
Middle Name:TONY
Last Name:PALACKAL
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 1:7 POPHAM RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3712
Mailing Address - Country:US
Mailing Address - Phone:914-723-3443
Mailing Address - Fax:
Practice Address - Street 1:7 POPHAM RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3712
Practice Address - Country:US
Practice Address - Phone:914-723-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist