Provider Demographics
NPI:1891088324
Name:BABAKHANOVA, YULIYA
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:BABAKHANOVA
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 1:3217 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1502
Mailing Address - Country:US
Mailing Address - Phone:718-868-2200
Mailing Address - Fax:718-868-1518
Practice Address - Street 1:3217 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1502
Practice Address - Country:US
Practice Address - Phone:718-868-2200
Practice Address - Fax:718-868-1518
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist