Provider Demographics
NPI:1841747227
Name:YAKOVLEVA, NATALYA
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:YAKOVLEVA
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 1:8800 20TH AVE APT 9D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4820
Mailing Address - Country:US
Mailing Address - Phone:718-333-3423
Mailing Address - Fax:
Practice Address - Street 1:223 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4219
Practice Address - Country:US
Practice Address - Phone:908-583-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03785800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist