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General NPI Number Information
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NPI Number | 1992301147
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Entity Type | Individual
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Provider Name | YELENA AGAKHANOVA
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Gender | Female
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 520 WALDO ST
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City | RUMFORD
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State | ME
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Zip | 04276-1617
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Country | US
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Telephone | 207-364-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 520 WALDO ST
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City | RUMFORD
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State | ME
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Zip | 04276-1617
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Country | US
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Telephone | 860-992-7858
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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 | PHCY-00984
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0013474
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PR45417
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License Number State | ME
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