Provider Demographics
NPI:1417279696
Name:SHPAK, OLIVIA G (RPH)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:G
Last Name:SHPAK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 KILMER LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3103
Mailing Address - Country:US
Mailing Address - Phone:516-642-1698
Mailing Address - Fax:
Practice Address - Street 1:315 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2247
Practice Address - Country:US
Practice Address - Phone:646-486-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist