Provider Demographics
NPI:1053643577
Name:NATANOV, LARISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:NATANOV
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13850 84TH DR
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1840
Mailing Address - Country:US
Mailing Address - Phone:917-575-2728
Mailing Address - Fax:
Practice Address - Street 1:13850 84TH DR
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1840
Practice Address - Country:US
Practice Address - Phone:718-223-4593
Practice Address - Fax:718-223-4594
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049091I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist