Provider Demographics
NPI:1225336761
Name:KASHTELYAN-JAKOBSON, DIANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KASHTELYAN-JAKOBSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:JAKOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:85 KALKO DR
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2026
Mailing Address - Country:US
Mailing Address - Phone:203-217-9415
Mailing Address - Fax:203-441-4118
Practice Address - Street 1:85 KALKO DR
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2026
Practice Address - Country:US
Practice Address - Phone:203-217-9415
Practice Address - Fax:203-441-4118
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050339183500000X
CT11443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist