Provider Demographics
NPI:1003868183
Name:BOROKHOVICH, TATYANA F (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:F
Last Name:BOROKHOVICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 BLACKBURN AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4400
Mailing Address - Country:US
Mailing Address - Phone:818-886-4900
Mailing Address - Fax:818-886-2309
Practice Address - Street 1:19631 PARTHENIA ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3408
Practice Address - Country:US
Practice Address - Phone:818-886-4900
Practice Address - Fax:818-886-2309
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist