Provider Demographics
NPI:1225309180
Name:BADALOVA, INNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:BADALOVA
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 1:6801 19TH AVE APT 2P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4467
Mailing Address - Country:US
Mailing Address - Phone:718-915-1266
Mailing Address - Fax:
Practice Address - Street 1:6801 19TH AVE APT 2P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4467
Practice Address - Country:US
Practice Address - Phone:718-915-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist