Provider Demographics
NPI:1568050417
Name:NAGORNAYA, ILONA A (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ILONA
Middle Name:A
Last Name:NAGORNAYA
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 1:310 OWEN AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-1560
Mailing Address - Country:US
Mailing Address - Phone:401-359-4604
Mailing Address - Fax:
Practice Address - Street 1:1103 KEMPTON ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1530
Practice Address - Country:US
Practice Address - Phone:508-990-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist