Provider Demographics
NPI:1689645251
Name:TAKHALOVA, VIKTORIYA
Entity Type:Individual
Prefix:MRS
First Name:VIKTORIYA
Middle Name:
Last Name:TAKHALOVA
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 1:1403 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1726
Mailing Address - Country:US
Mailing Address - Phone:718-724-1333
Mailing Address - Fax:718-724-2333
Practice Address - Street 1:1403 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1726
Practice Address - Country:US
Practice Address - Phone:718-724-1333
Practice Address - Fax:718-724-2333
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist