Provider Demographics
NPI:1194097071
Name:BIRBRAYER, YANA (RPH)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:BIRBRAYER
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 1:1050 GATEWAY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8368
Mailing Address - Country:US
Mailing Address - Phone:561-200-4245
Mailing Address - Fax:561-200-4236
Practice Address - Street 1:1050 GATEWAY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8368
Practice Address - Country:US
Practice Address - Phone:561-200-4245
Practice Address - Fax:561-200-4236
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist