Provider Demographics
NPI:1891156006
Name:PYATETSKY, INNA
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:PYATETSKY
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 1:8200 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2519
Mailing Address - Country:US
Mailing Address - Phone:215-338-4967
Mailing Address - Fax:215-338-2437
Practice Address - Street 1:8200 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2519
Practice Address - Country:US
Practice Address - Phone:215-338-4967
Practice Address - Fax:215-338-2437
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist