MEDICARE: MRS. VIKTORIYA TAKHALOVA

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	047973	NY

General Provider Information

NPI Number	:	1689645251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIKTORIYA TAKHALOVA

Provider Business Mailing Address
First Line	:	1403 FOSTER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1726
Country	:	US
Telephone Number	:	718-724-1333
Fax Number	:	718-724-2333

Provider Business Practice Location Address
First Line	:	1403 FOSTER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1726
Country	:	US
Telephone Number	:	718-724-1333
Fax Number	:	718-724-2333

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	03/17/2010

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