MEDICARE: ANGELA AMINOVA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	045420	NY

General Provider Information

NPI Number	:	1316279177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA AMINOVA RPH

Provider Business Mailing Address
First Line	:	8432 JAMAICA AVE
Second Line	:
City	:	WOODHAVEN
State	:	NY
Zip	:	11421-1920
Country	:	US
Telephone Number	:	718-277-5814
Fax Number	:	718-277-7599

Provider Business Practice Location Address
First Line	:	8432 JAMAICA AVE
Second Line	:
City	:	WOODHAVEN
State	:	NY
Zip	:	11421-1920
Country	:	US
Telephone Number	:	718-277-5814
Fax Number	:	718-277-7599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	11/09/2016

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