Provider Demographics
NPI:1235371006
Name:YAKUBOVA, ZHANNA
Entity Type:Individual
Prefix:MS
First Name:ZHANNA
Middle Name:
Last Name:YAKUBOVA
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 1:1925 OCEAN AVE APT 2G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6844
Mailing Address - Country:US
Mailing Address - Phone:917-723-3500
Mailing Address - Fax:
Practice Address - Street 1:395 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4103
Practice Address - Country:US
Practice Address - Phone:718-222-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist