Provider Demographics
NPI:1003950452
Name:YAKUBOV, ELINA (RPH)
Entity Type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18118 KILDARE RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1534
Mailing Address - Country:US
Mailing Address - Phone:718-380-0129
Mailing Address - Fax:718-897-6057
Practice Address - Street 1:691 CO OP CITY BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1673
Practice Address - Country:US
Practice Address - Phone:718-862-2847
Practice Address - Fax:718-379-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist