=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609108463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VITALINA SHLAFMAN PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2010
-----------------------------------------------------
Last Update Date | 02/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2456 RICHMOND AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-5804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-697-0422
-----------------------------------------------------
Fax | 718-697-0427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 773 PATTERSON AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-979-8279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 052839
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------