Provider Demographics
NPI:1841547171
Name:MINZBERG, YANA (RPH)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:MINZBERG
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 1:1260 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2833
Mailing Address - Country:US
Mailing Address - Phone:617-361-3030
Mailing Address - Fax:617-361-3066
Practice Address - Street 1:1260 RIVER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2833
Practice Address - Country:US
Practice Address - Phone:617-361-3030
Practice Address - Fax:617-361-3066
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist