Provider Demographics
NPI:1194321026
Name:KHUSAINOVA, RENATA (PHARMD)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:KHUSAINOVA
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 1:7701 BAY PKWY APT 6F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1527
Mailing Address - Country:US
Mailing Address - Phone:347-260-2733
Mailing Address - Fax:
Practice Address - Street 1:320 SMITH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4608
Practice Address - Country:US
Practice Address - Phone:718-403-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist