Healthcare Provider Details

I. General information

NPI: 1760023667
Provider Name (Legal Business Name): SHAMUEL BORUKHOV PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 108TH ST
FOREST HILLS NY
11375-1612
US

IV. Provider business mailing address

6145 98TH ST APT 7H
REGO PARK NY
11374-1429
US

V. Phone/Fax

Practice location:
  • Phone: 516-304-5038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: