Provider Demographics
NPI:1679896880
Name:NASONOVA, OLGA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:OLGA
Middle Name:
Last Name:NASONOVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 UNION AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3354
Mailing Address - Country:US
Mailing Address - Phone:516-802-2347
Mailing Address - Fax:
Practice Address - Street 1:1829 GRAND AVE
Practice Address - Street 2:CVS/PHARMACY
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2453
Practice Address - Country:US
Practice Address - Phone:516-378-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist