Provider Demographics
NPI:1174640395
Name:EPSHTEYN, MIKHAIL G (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:G
Last Name:EPSHTEYN
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 1:18890 CONCORD ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1118
Mailing Address - Country:US
Mailing Address - Phone:763-633-0942
Mailing Address - Fax:
Practice Address - Street 1:1300 HIDDEN LAKES PKWY
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4286
Practice Address - Country:US
Practice Address - Phone:763-302-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist