Provider Demographics
NPI:1083048797
Name:ABRAMOV, BORIS D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:D
Last Name:ABRAMOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14418 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2007
Mailing Address - Country:US
Mailing Address - Phone:913-710-3380
Mailing Address - Fax:
Practice Address - Street 1:14418 71ST AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2007
Practice Address - Country:US
Practice Address - Phone:913-710-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-17018183500000X
CTPCT.0012817183500000X
NY061564-1183500000X
MO2013022753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist