Provider Demographics
NPI:1700480167
Name:SHLEMANOVA, YULIYA
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:SHLEMANOVA
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 1:14 KATIE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01128-1038
Mailing Address - Country:US
Mailing Address - Phone:413-219-0047
Mailing Address - Fax:
Practice Address - Street 1:239B MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4005
Practice Address - Country:US
Practice Address - Phone:413-732-3119
Practice Address - Fax:413-746-5085
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist