Provider Demographics
NPI:1851623276
Name:MAZARA, JOSEPHINE (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:MAZARA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6601
Mailing Address - Country:US
Mailing Address - Phone:718-261-1647
Mailing Address - Fax:718-261-2595
Practice Address - Street 1:9715 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6601
Practice Address - Country:US
Practice Address - Phone:718-261-1647
Practice Address - Fax:718-261-2595
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist