Individual provider Active NPI

Elana Mirakova

  • Pharmacist
  • Fresh Meadows, NY
National Provider Identifier
1104429877
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
067121 Issued in NY
Practice address
16406 69TH Ave
Fresh Meadows, NY 11365-3202
Phone
(718) 380-3330
NPI assigned
Nov 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 067121 NY Primary

Addresses

Primary practice location

16406 69TH Ave
Fresh Meadows, NY 11365-3202

Mailing address

16406 69TH Ave
Fresh Meadows, NY 11365-3202
Phone (718) 380-3330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
067121NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
True-Care Pharmacy Corp CurrentSince Sep 15, 2024 Accepting new patients
True-Care Pharmacy Corp PastSince Mar 27, 2022 Accepting new patients

Locations

16406 69th Ave
Fresh Meadows, NY 11365
Phone (718) 380-3330

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1104429877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16406 69TH AVE",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653202",
            "telephone_number": "718-380-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16406 69TH AVE",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653202",
            "telephone_number": "718-380-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRAKOVA",
        "first_name": "ELANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-17",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "067121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresh Meadows, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.