Healthcare Provider Details

I. General information

NPI: 1982914438
Provider Name (Legal Business Name): GRIGORIY KANDKHOROV PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 WILLIAMSBRIDGE RD
BRONX NY
10461-1605
US

IV. Provider business mailing address

8330 118TH ST APT 5H
KEW GARDENS NY
11415-2374
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-7568
  • Fax:
Mailing address:
  • Phone: 646-302-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number055055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: