Provider Demographics
NPI:1194933341
Name:YAKUTILOV, ROBERT Y (PHARM-D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:Y
Last Name:YAKUTILOV
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:Y
Other - Last Name:YAKUTILOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:10817 65TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1842
Mailing Address - Country:US
Mailing Address - Phone:646-684-7118
Mailing Address - Fax:
Practice Address - Street 1:10817 65TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11375-1842
Practice Address - Country:US
Practice Address - Phone:646-684-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist