Provider Demographics
NPI:1427472695
Name:KHAVASOVA, ELLA
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:KHAVASOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLA
Other - Middle Name:
Other - Last Name:KHAVASOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:49 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5965
Mailing Address - Country:US
Mailing Address - Phone:212-888-2323
Mailing Address - Fax:
Practice Address - Street 1:49 E 52ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5965
Practice Address - Country:US
Practice Address - Phone:212-888-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist