Provider Demographics
NPI:1609358258
Name:KOVALEVSKAYA, VLADLENA
Entity Type:Individual
Prefix:
First Name:VLADLENA
Middle Name:
Last Name:KOVALEVSKAYA
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 1:1730 E 14TH ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2051
Mailing Address - Country:US
Mailing Address - Phone:347-409-7757
Mailing Address - Fax:
Practice Address - Street 1:1610 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3810
Practice Address - Country:US
Practice Address - Phone:718-376-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist