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General NPI Number Information
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NPI Number | 1902375454
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Entity Type | Individual
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Provider Name | VENIAMIN RETINSKIY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 80 PINNACLES DR STE 900
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City | PALM COAST
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State | FL
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Zip | 32164-2915
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Country | US
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Telephone | 386-313-5995
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Fax | 386-313-5996
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Provider Business Mailing Address
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Address Line | 107 SEATTLE TRL
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City | PALM COAST
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State | FL
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Zip | 32164-5531
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Country | US
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Telephone | 386-334-6559
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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 | PS57221
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License Number State | FL
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