Provider Demographics
NPI:1437740479
Name:YUNATANOV, ERICA SHARONA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:SHARONA
Last Name:YUNATANOV
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 1:2433 KNAPP ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1005
Mailing Address - Country:US
Mailing Address - Phone:718-880-8980
Mailing Address - Fax:
Practice Address - Street 1:10326 68TH AVE APT 2D
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3217
Practice Address - Country:US
Practice Address - Phone:718-406-5425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist