Provider Demographics
NPI:1962786772
Name:HOLSTEIN, JESSICA ERIN (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:HOLSTEIN
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 1:230 W 55TH ST
Mailing Address - Street 2:APT 9H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5220
Mailing Address - Country:US
Mailing Address - Phone:410-952-5775
Mailing Address - Fax:
Practice Address - Street 1:568 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3407
Practice Address - Country:US
Practice Address - Phone:212-865-3894
Practice Address - Fax:212-865-2382
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055340183500000X
MD19990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist