Provider Demographics
NPI:1891229167
Name:AYZENBERG, YELENA (PHARM D)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:AYZENBERG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2364
Mailing Address - Country:US
Mailing Address - Phone:805-581-1800
Mailing Address - Fax:805-581-5315
Practice Address - Street 1:3935 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2364
Practice Address - Country:US
Practice Address - Phone:805-581-1800
Practice Address - Fax:805-581-5315
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist