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NPI Code Detail

MEDICARE: OLGA MIRONOVA PHARM D

MEDICARE: OLGA MIRONOVA PHARM D
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
1183500000XPharmacist057123NY

General Provider Information

NPI Number : 1255773628
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLGA MIRONOVA PHARM D
Provider Business Mailing Address
First Line : 1440 W 4TH ST APT 1A
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-4084
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 519 GATEWAY DR
Second Line :
City : BROOKLYN
State : NY
Zip : 11239-2801
Country : US
Telephone Number : 718-235-6032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2013
Last Update Date : 07/25/2013

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Directions to “ OLGA MIRONOVA PHARM D” Practice Location

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