Provider Demographics
NPI:1679149603
Name:POVALIAEV, VALER (PHARMD)
Entity Type:Individual
Prefix:
First Name:VALER
Middle Name:
Last Name:POVALIAEV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 OCEAN AVE APT 8A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3550
Mailing Address - Country:US
Mailing Address - Phone:347-284-8416
Mailing Address - Fax:
Practice Address - Street 1:1532 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3431
Practice Address - Country:US
Practice Address - Phone:718-234-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist