Provider Demographics
NPI:1275898801
Name:PUSTILNIKOVA, ANNA Y (RPH, PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:Y
Last Name:PUSTILNIKOVA
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MYSTIC VIEW RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-2428
Mailing Address - Country:US
Mailing Address - Phone:617-420-0001
Mailing Address - Fax:
Practice Address - Street 1:1 MYSTIC VIEW RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-2428
Practice Address - Country:US
Practice Address - Phone:617-420-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist