Healthcare Provider Details

I. General information

NPI: 1063699536
Provider Name (Legal Business Name): YELENA KUZNETSOVA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRIGHTON 11TH ST
BROOKLYN NY
11235-5304
US

IV. Provider business mailing address

10 BRIGHTON 11TH ST
BROOKLYN NY
11235-5304
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-4006
  • Fax: 718-676-4027
Mailing address:
  • Phone: 718-676-4006
  • Fax: 718-676-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: