Healthcare Provider Details

I. General information

NPI: 1285196352
Provider Name (Legal Business Name): VERONIKA TYATINA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OLD TOWN RD
STATEN ISLAND NY
10305-1415
US

IV. Provider business mailing address

35 WILSONVIEW PL
STATEN ISLAND NY
10304-1520
US

V. Phone/Fax

Practice location:
  • Phone: 718-489-4994
  • Fax:
Mailing address:
  • Phone: 347-750-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: