Provider Demographics
NPI:1215185822
Name:SHAULOVA, DIANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:SHAULOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:SHAULOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7537 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3136
Mailing Address - Country:US
Mailing Address - Phone:718-263-8100
Mailing Address - Fax:718-263-8111
Practice Address - Street 1:7537 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3136
Practice Address - Country:US
Practice Address - Phone:718-263-8100
Practice Address - Fax:718-263-8111
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist