Provider Demographics
NPI:1104076561
Name:YANNOTTI, JAMIE (RPH)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:YANNOTTI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3420
Mailing Address - Country:US
Mailing Address - Phone:631-691-0342
Mailing Address - Fax:631-691-0195
Practice Address - Street 1:351 MERRICK RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3420
Practice Address - Country:US
Practice Address - Phone:631-691-0342
Practice Address - Fax:631-691-0195
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02693492Medicaid