Provider Demographics
NPI:1962893438
Name:YAKOVLEV, MIHAIL
Entity type:Individual
Prefix:
First Name:MIHAIL
Middle Name:
Last Name:YAKOVLEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17156 EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7337
Mailing Address - Country:US
Mailing Address - Phone:952-261-9611
Mailing Address - Fax:
Practice Address - Street 1:8225 FLYING CLOUD DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5315
Practice Address - Country:US
Practice Address - Phone:952-944-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN728689183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician