Provider Demographics
NPI:1912221227
Name:KRASS, SVETLANA (RPH)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:KRASS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9890A QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4354
Mailing Address - Country:US
Mailing Address - Phone:718-459-1500
Mailing Address - Fax:718-459-5956
Practice Address - Street 1:9890A QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4354
Practice Address - Country:US
Practice Address - Phone:718-459-1500
Practice Address - Fax:718-459-5956
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist