Provider Demographics
NPI:1386230811
Name:MCDERMOTT, POLINA YEVGENYEVNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:POLINA
Middle Name:YEVGENYEVNA
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:POLINA
Other - Middle Name:YEVGENYEVNA
Other - Last Name:PULYANINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 FLICKER DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6621
Mailing Address - Country:US
Mailing Address - Phone:909-360-3752
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:909-360-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist