Healthcare Provider Details

I. General information

NPI: 1760893416
Provider Name (Legal Business Name): YANA BUKOVSKAYA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST GRB005
BOSTON MA
02114-2621
US

IV. Provider business mailing address

44 WOODBRIDGE TER APT C
WOODBRIDGE NJ
07095-4276
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-2416
  • Fax:
Mailing address:
  • Phone: 732-447-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: