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General NPI Number Information
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NPI Number | 1295340313
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Entity Type | Individual
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Provider Name | BORIS D YUNATANOV
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Gender | Male
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 711 BEDFORD AVE
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City | BROOKLYN
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State | NY
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Zip | 11206-5428
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Country | US
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Telephone | 718-855-0214
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Fax |
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Provider Business Mailing Address
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Address Line | 6420 SAUNDERS ST APT D5
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City | REGO PARK
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State | NY
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Zip | 11374-3204
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Country | US
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Telephone | 718-687-9043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 066959
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License Number State | NY
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