Healthcare Provider Details

I. General information

NPI: 1538818562
Provider Name (Legal Business Name): WIKTORIA BOGDANSKA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

475 48TH AVE APT 806
LONG ISLAND CITY NY
11109-5510
US

V. Phone/Fax

Practice location:
  • Phone: 860-518-2378
  • Fax:
Mailing address:
  • Phone: 860-518-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPCT.0014841
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number067021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: