Provider Demographics
NPI:1285766477
Name:SLYUSARANSKAYA, YELENA (RPH)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:SLYUSARANSKAYA
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 1:14618 VICTORY BLVD # B
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1621
Mailing Address - Country:US
Mailing Address - Phone:818-376-8316
Mailing Address - Fax:818-376-1581
Practice Address - Street 1:14618 VICTORY BLVD # B
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1621
Practice Address - Country:US
Practice Address - Phone:818-376-8316
Practice Address - Fax:818-376-1581
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist