Provider Demographics
NPI:1558925404
Name:SHTIVELMAN, SVETLANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:SHTIVELMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 SHELTER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-6059
Mailing Address - Country:US
Mailing Address - Phone:818-568-6937
Mailing Address - Fax:
Practice Address - Street 1:1871 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3220
Practice Address - Country:US
Practice Address - Phone:650-692-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist