Provider Demographics
NPI:1750358842
Name:CERNY, MICHELE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:MARIE
Last Name:CERNY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:JAKUBOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:26 BOKEL RD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6707
Mailing Address - Country:US
Mailing Address - Phone:631-901-4887
Mailing Address - Fax:631-585-8038
Practice Address - Street 1:1036 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1606
Practice Address - Country:US
Practice Address - Phone:631-585-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist