Provider Demographics
NPI:1245562495
Name:KHAFIZOVA, YULIYA (PHARM-D)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:KHAFIZOVA
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 135TH ST APT 319
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1043
Mailing Address - Country:US
Mailing Address - Phone:718-268-8506
Mailing Address - Fax:
Practice Address - Street 1:4108 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2802
Practice Address - Country:US
Practice Address - Phone:718-361-6014
Practice Address - Fax:718-433-2970
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist