Provider Demographics
NPI:1669686499
Name:YANVARASHVILI, RENA
Entity Type:Individual
Prefix:MRS
First Name:RENA
Middle Name:
Last Name:YANVARASHVILI
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 1:14 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1720
Mailing Address - Country:US
Mailing Address - Phone:516-792-9009
Mailing Address - Fax:718-372-0797
Practice Address - Street 1:2201 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5603
Practice Address - Country:US
Practice Address - Phone:718-372-0797
Practice Address - Fax:718-372-0797
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist