Provider Demographics
NPI:1184948952
Name:SYLLA, ABOUBACAR (PHARMD)
Entity type:Individual
Prefix:
First Name:ABOUBACAR
Middle Name:
Last Name:SYLLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W END AVE
Mailing Address - Street 2:APT# 9F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6349
Mailing Address - Country:US
Mailing Address - Phone:917-331-5912
Mailing Address - Fax:
Practice Address - Street 1:1600 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3994
Practice Address - Country:US
Practice Address - Phone:212-369-3084
Practice Address - Fax:212-423-3037
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist