Provider Demographics
NPI:1336504679
Name:MULLOKANDOVA, YELENA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:MULLOKANDOVA
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 1:9750 QUEENS BLVD
Mailing Address - Street 2:APT A3
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3252
Mailing Address - Country:US
Mailing Address - Phone:347-819-1940
Mailing Address - Fax:
Practice Address - Street 1:3214 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2643
Practice Address - Country:US
Practice Address - Phone:718-728-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist