Provider Demographics
NPI:1851613632
Name:YAISH, NOURI (RPH)
Entity Type:Individual
Prefix:MR
First Name:NOURI
Middle Name:
Last Name:YAISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454
Mailing Address - Country:US
Mailing Address - Phone:718-292-4244
Mailing Address - Fax:718-292-1249
Practice Address - Street 1:1610 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3810
Practice Address - Country:US
Practice Address - Phone:718-376-7600
Practice Address - Fax:718-376-7601
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist