Healthcare Provider Details

I. General information

NPI: 1609292291
Provider Name (Legal Business Name): MIKHAIL IGLIN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

3901 INDEPENDENCE AVE APT. 6K
BRONX NY
10463-1219
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI057190-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: