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NPI Code Detail

MEDICARE: MRS. RENA YANVARASHVILI

MEDICARE: MRS. RENA YANVARASHVILI
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
1183500000XPharmacist045607NY

General Provider Information

NPI Number : 1669686499
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RENA YANVARASHVILI
Provider Business Mailing Address
First Line : 14 BURTON AVE
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1720
Country : US
Telephone Number : 516-792-9009
Fax Number : 718-372-0797
Provider Business Practice Location Address
First Line : 2201 BATH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-5603
Country : US
Telephone Number : 718-372-0797
Fax Number : 718-372-0797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 03/25/2010

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