MEDICARE: YANINA DUBROVSKAYA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051130	NY

General Provider Information

NPI Number	:	1255710737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANINA DUBROVSKAYA PHARMD

Provider Business Mailing Address
First Line	:	2479 WEST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5917
Country	:	US
Telephone Number	:	347-740-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 1ST AVE
Second Line	:	GREENBERG HALL, SC2-097
City	:	NEW YORK
State	:	NY
Zip	:	10016-6401
Country	:	US
Telephone Number	:	212-263-6436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	05/29/2015

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