Provider Demographics
NPI:1275865636
Name:PUSTYLNIK-SLYUSERANSKY, IRENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IRENA
Middle Name:
Last Name:PUSTYLNIK-SLYUSERANSKY
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 1:2370 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5034
Mailing Address - Country:US
Mailing Address - Phone:718-449-4949
Mailing Address - Fax:718-449-4893
Practice Address - Street 1:1826 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4511
Practice Address - Country:US
Practice Address - Phone:718-872-6655
Practice Address - Fax:718-872-6556
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist