Provider Demographics
NPI:1376146233
Name:VYUNSKOVSKAYA, PANIDA
Entity Type:Individual
Prefix:
First Name:PANIDA
Middle Name:
Last Name:VYUNSKOVSKAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1306
Mailing Address - Country:US
Mailing Address - Phone:508-373-6495
Mailing Address - Fax:
Practice Address - Street 1:67 PLEASANT VALLEY ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7202
Practice Address - Country:US
Practice Address - Phone:978-983-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist