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General NPI Number Information
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NPI Number | 1154671832
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Entity Type | Individual
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Provider Name | MARK TARTAKOVSKY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 121 DEKALB AVE
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City | BROOKLYN
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State | NY
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Zip | 11201-5425
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Country | US
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Telephone | 718-250-7998
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Fax | 718-250-6163
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Provider Business Mailing Address
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Address Line | 506 ORIENTAL BLVD
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 845-553-5600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 057110-1
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License Number State | NY
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