Provider Demographics
NPI:1306221205
Name:POTIHA, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:POTIHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OCEAN PKWY
Mailing Address - Street 2:APT 23U
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 OCEAN PKWY
Practice Address - Street 2:APT 23U
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8374
Practice Address - Country:US
Practice Address - Phone:347-967-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060198183500000X
NJ28RI03695100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist