Provider Demographics
NPI:1700320330
Name:BLINAVA, ANNA LVOVNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LVOVNA
Last Name:BLINAVA
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 1:2730 W 33RD ST APT 7F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1644
Mailing Address - Country:US
Mailing Address - Phone:718-730-4994
Mailing Address - Fax:
Practice Address - Street 1:8330 BUSTLETON AVE BELLS MARKET PHARMACY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-342-1697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449475183500000X
DEA1-0004438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist