Provider Demographics
NPI:1992301147
Name:AGAKHANOVA, YELENA
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:AGAKHANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WALDO ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-1617
Mailing Address - Country:US
Mailing Address - Phone:860-992-7858
Mailing Address - Fax:
Practice Address - Street 1:520 WALDO ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-1617
Practice Address - Country:US
Practice Address - Phone:207-364-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-00984183500000X
CTPCT.0013474183500000X
MEPR45417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist