Healthcare Provider Details

I. General information

NPI: 1194187674
Provider Name (Legal Business Name): YEGOR KAMENSKI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16225 SIERRA LAKES PKWY
FONTANA CA
92336-1245
US

IV. Provider business mailing address

16225 SIERRA LAKES PKWY
FONTANA CA
92336-1245
US

V. Phone/Fax

Practice location:
  • Phone: 909-357-1380
  • Fax:
Mailing address:
  • Phone: 909-357-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 74355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: