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General NPI Number Information
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NPI Number | 1194158196
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Entity Type | Individual
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Provider Name | GEORGIY POLYAK PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 2577 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11210-4640
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Country | US
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Telephone | 718-258-1812
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Fax |
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Provider Business Mailing Address
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Address Line | RR 1 BOX 508
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City | DINGMANS FERRY
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State | PA
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Zip | 18328-9744
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Country | US
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Telephone | 646-648-0311
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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 | 20058383
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License Number State | NY
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