Provider Demographics
NPI:1194979476
Name:SHALOMOV, ELLA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:SHALOMOV
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 1:6115 98TH ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1407
Mailing Address - Country:US
Mailing Address - Phone:917-216-7993
Mailing Address - Fax:347-738-4560
Practice Address - Street 1:773 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8531
Practice Address - Country:US
Practice Address - Phone:212-829-0651
Practice Address - Fax:212-829-9378
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528361835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy