Provider Demographics
NPI:1467887935
Name:YUABOV, GRIGORIY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GRIGORIY
Middle Name:
Last Name:YUABOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 164TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1209
Mailing Address - Country:US
Mailing Address - Phone:347-209-9254
Mailing Address - Fax:
Practice Address - Street 1:7840 164TH ST APT 3D
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1209
Practice Address - Country:US
Practice Address - Phone:347-209-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist