Provider Demographics
NPI:1821401670
Name:SELYUZHITSKI, NATALIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:SELYUZHITSKI
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 1:295 TOWER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13480-1127
Mailing Address - Country:US
Mailing Address - Phone:315-507-0046
Mailing Address - Fax:
Practice Address - Street 1:27 ROUND LAKE RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1129
Practice Address - Country:US
Practice Address - Phone:518-899-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist