Provider Demographics
NPI:1801204235
Name:YAKUBOVA, MARIYA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:YAKUBOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6577 PARSONS BLVD APT 2F
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2408
Mailing Address - Country:US
Mailing Address - Phone:212-729-3717
Mailing Address - Fax:
Practice Address - Street 1:6577 PARSONS BLVD APT 2F
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2408
Practice Address - Country:US
Practice Address - Phone:212-729-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist