Provider Demographics
NPI:1083882609
Name:YUSUPOVA, ESTHER (RPH)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:
Last Name:YUSUPOVA
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 1:941 CARMANS RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3504
Mailing Address - Country:US
Mailing Address - Phone:516-797-5477
Mailing Address - Fax:516-797-5480
Practice Address - Street 1:1764 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2431
Practice Address - Country:US
Practice Address - Phone:516-223-2020
Practice Address - Fax:516-546-4312
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048366OtherNY STATE LICENSE