Provider Demographics
NPI:1598521221
Name:VARDANYAN, YAROSLAVA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YAROSLAVA
Middle Name:
Last Name:VARDANYAN
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 1:101 DIPLOMAT PKWY APT 1011
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3892
Mailing Address - Country:US
Mailing Address - Phone:347-854-8327
Mailing Address - Fax:
Practice Address - Street 1:101 DIPLOMAT PKWY APT 1011
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3892
Practice Address - Country:US
Practice Address - Phone:347-854-8327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist