Provider Demographics
NPI:1356522973
Name:AGARONOVA, ELINA (RPH)
Entity type:Individual
Prefix:MRS
First Name:ELINA
Middle Name:
Last Name:AGARONOVA
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 1:520 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1941
Mailing Address - Country:US
Mailing Address - Phone:718-375-8911
Mailing Address - Fax:718-375-7428
Practice Address - Street 1:520 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1941
Practice Address - Country:US
Practice Address - Phone:718-375-8911
Practice Address - Fax:718-375-7428
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046906-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist