Provider Demographics
NPI:1720531270
Name:BANKOFF, JILLIAN MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:MARIE
Last Name:BANKOFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4239
Mailing Address - Country:US
Mailing Address - Phone:631-588-1590
Mailing Address - Fax:631-588-7315
Practice Address - Street 1:407 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4239
Practice Address - Country:US
Practice Address - Phone:631-588-1590
Practice Address - Fax:631-588-7315
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI061852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist