Healthcare Provider Details

I. General information

NPI: 1952013971
Provider Name (Legal Business Name): NATALIYA M ZAVZYATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 STATE HIGHWAY 6 S
COLLEGE STATION TX
77845-4506
US

IV. Provider business mailing address

5409 CROSSWATER DR
COLLEGE STATION TX
77845-3785
US

V. Phone/Fax

Practice location:
  • Phone: 979-321-6560
  • Fax: 979-321-6551
Mailing address:
  • Phone: 718-685-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57719
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: