Active NPI
Irina Pustovalova, PHARM.D.
- Pharmacist
- Liverpool, NY
National Provider Identifier
1174803191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 055459
- Practice address
- 219 Grenadier Dr Apt F
Liverpool, NY 13090-2757 - Phone
- (315) 622-3563
- NPI assigned
- Aug 22, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 055459 | NY | Primary |
Addresses
Primary practice location
219 Grenadier Dr Apt F
Liverpool, NY 13090-2757
Mailing address
219 Grenadier Dr Apt F
Liverpool, NY 13090-2757
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055459 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313971200000",
"number": "1174803191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "219 GRENADIER DR APT F",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130902757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 GRENADIER DR APT F",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130902757",
"telephone_number": "315-622-3563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUSTOVALOVA",
"first_name": "IRINA",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-22",
"last_updated": "2011-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "055459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liverpool, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.