Provider Demographics
NPI:1184990632
Name:DAVYDOV, YURIY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:YURIY
Middle Name:
Last Name:DAVYDOV
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PENNY POND CT
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1400
Mailing Address - Country:US
Mailing Address - Phone:646-633-2170
Mailing Address - Fax:
Practice Address - Street 1:1299 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5503
Practice Address - Country:US
Practice Address - Phone:212-535-1700
Practice Address - Fax:212-535-1722
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6708670001Medicare NSC