MEDICARE: MAKSIM PLATONOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	055775	NY

General Provider Information

NPI Number	:	1366720815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKSIM PLATONOV

Provider Business Mailing Address
First Line	:	862 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	862 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3102
Country	:	US
Telephone Number	:	718-282-4777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2011
Last Update Date	:	05/10/2021

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