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General NPI Number Information
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NPI Number | 1568050417
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Entity Type | Individual
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Provider Name | ILONA A NAGORNAYA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 1103 KEMPTON ST
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City | NEW BEDFORD
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State | MA
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Zip | 02740-1530
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Country | US
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Telephone | 508-990-3765
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Fax |
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Provider Business Mailing Address
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Address Line | 310 OWEN AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-1560
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Country | US
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Telephone | 401-359-4604
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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 | PH237188
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License Number State | MA
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