MEDICARE: MS. YANA VASHAKIDZE 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	183500000X	Pharmacist	053745	NY

General Provider Information

NPI Number	:	1891028601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YANA VASHAKIDZE PHARMD

Provider Business Mailing Address
First Line	:	2106 77TH ST APT 2F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1551
Country	:	US
Telephone Number	:	718-259-5235
Fax Number	:

Provider Business Practice Location Address
First Line	:	542 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-4804
Country	:	US
Telephone Number	:	718-284-9800
Fax Number	:

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

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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