MEDICARE: SVETLANA GOZENPUD

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	049611	NY

General Provider Information

NPI Number	:	1851572432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA GOZENPUD

Provider Business Mailing Address
First Line	:	1401 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2093
Country	:	US
Telephone Number	:	718-627-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2093
Country	:	US
Telephone Number	:	718-627-9199
Fax Number	:

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

Provider Enumeration Date	:	11/23/2007
Last Update Date	:	11/23/2007

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Directions to “ SVETLANA GOZENPUD ” Practice Location

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