Provider Demographics
NPI:1912769811
Name:YUSKO, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:YUSKO
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 1:13 MILES RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5126
Mailing Address - Country:US
Mailing Address - Phone:190-857-8345
Mailing Address - Fax:
Practice Address - Street 1:600 DERBY AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1000
Practice Address - Country:US
Practice Address - Phone:877-487-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist