Basic Information
| Provider Information | |||||||||
| NPI: | 1235454117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMEH | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | UGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32302 | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186045363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 585 SCHENECTADY AVENUE | ||||||||
| Address2: | DEPARTMENT PHARMACY | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186045363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2010 | ||||||||
| LastUpdateDate: | 04/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 042547 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.