Basic Information
Provider Information | |||||||||
NPI: | 1104165380 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YUHASZ | ||||||||
FirstName: | EMORY | ||||||||
MiddleName: | JAMES | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | B.S. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | YUHASZ | ||||||||
OtherFirstName: | NANCY | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | B.S. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 11050 MOUNT BELVEDERE BLVD | ||||||||
Address2: |   | ||||||||
City: | FORT DRUM | ||||||||
State: | NY | ||||||||
PostalCode: | 136025438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3157720668 | ||||||||
FaxNumber: | 3157721691 | ||||||||
Practice Location | |||||||||
Address1: | 11050 MOUNT BELVEDERE BLVD | ||||||||
Address2: |   | ||||||||
City: | FORT DRUM | ||||||||
State: | NY | ||||||||
PostalCode: | 136025438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3157720668 | ||||||||
FaxNumber: | 3157721691 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/07/2013 | ||||||||
LastUpdateDate: | 02/07/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 029019-1 | NY | Y |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.