Healthcare Provider Details

I. General information

NPI: 1568076743
Provider Name (Legal Business Name): ALEKSANDR ZAVOROTYNSKIY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

8835 241ST ST
BELLEROSE NY
11426-1238
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-5160
  • Fax:
Mailing address:
  • Phone: 917-601-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066791
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: