Provider Demographics
NPI:1912301862
Name:YUSUPOV, YAFFA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YAFFA
Middle Name:
Last Name:YUSUPOV
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9708 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6626
Mailing Address - Country:US
Mailing Address - Phone:646-535-5915
Mailing Address - Fax:718-744-9702
Practice Address - Street 1:9708 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6626
Practice Address - Country:US
Practice Address - Phone:646-535-5915
Practice Address - Fax:718-744-9702
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist