Provider Demographics
NPI:1538788161
Name:KRAYTER, YELENA
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KRAYTER
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 1:9 PINE CONE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8683
Mailing Address - Country:US
Mailing Address - Phone:386-246-7898
Mailing Address - Fax:386-246-7515
Practice Address - Street 1:9 PINE CONE DR STE 109
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8683
Practice Address - Country:US
Practice Address - Phone:386-246-7898
Practice Address - Fax:386-246-7515
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist