Provider Demographics
NPI:1336368463
Name:YUSCHAK, DARIA F (RPH)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:F
Last Name:YUSCHAK
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 1:141 CODFISH HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-3203
Mailing Address - Country:US
Mailing Address - Phone:203-744-3768
Mailing Address - Fax:
Practice Address - Street 1:140 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2530
Practice Address - Country:US
Practice Address - Phone:203-744-0945
Practice Address - Fax:203-790-4169
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist