Provider Demographics
NPI:1790007672
Name:JAILALL, ANN
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:
Last Name:JAILALL
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 1:3029 12 ST.
Mailing Address - Street 2:
Mailing Address - City:L.I.C.
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2002
Mailing Address - Country:US
Mailing Address - Phone:718-626-9761
Mailing Address - Fax:
Practice Address - Street 1:200 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4801
Practice Address - Country:US
Practice Address - Phone:212-496-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052924-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist