Provider Demographics
NPI:1366673824
Name:VADAPYANAVA, LARYSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LARYSA
Middle Name:
Last Name:VADAPYANAVA
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 1:18 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4420
Mailing Address - Country:US
Mailing Address - Phone:917-755-9024
Mailing Address - Fax:
Practice Address - Street 1:5423 2ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2605
Practice Address - Country:US
Practice Address - Phone:718-439-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist