MEDICARE: YELENA DUBOVAYA PHARM. D.

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	051762	NY

General Provider Information

NPI Number	:	1801118823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA DUBOVAYA PHARM. D.

Provider Business Mailing Address
First Line	:	174 BRIGHTON 11TH ST FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5507
Country	:	US
Telephone Number	:	718-837-1471
Fax Number	:

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

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	03/20/2013

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