Provider Demographics
NPI:1043470172
Name:YAGHOUBIAN, DALYA (PHARM D)
Entity type:Individual
Prefix:
First Name:DALYA
Middle Name:
Last Name:YAGHOUBIAN
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 1:4512 GREENPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2410
Mailing Address - Country:US
Mailing Address - Phone:718-361-6060
Mailing Address - Fax:
Practice Address - Street 1:4512 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2410
Practice Address - Country:US
Practice Address - Phone:718-361-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist