Provider Demographics
NPI:1225522139
Name:MASHIYAKHOVA, LANA
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:MASHIYAKHOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PARKVILLE AVE APT 4J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1345
Mailing Address - Country:US
Mailing Address - Phone:347-481-6781
Mailing Address - Fax:
Practice Address - Street 1:531 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2409
Practice Address - Country:US
Practice Address - Phone:347-481-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist