Provider Demographics
NPI:1356825533
Name:BORUKHOVA, VERONIKA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:BORUKHOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 YELLOWSTONE BLVD APT 6C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5302
Mailing Address - Country:US
Mailing Address - Phone:347-604-2037
Mailing Address - Fax:
Practice Address - Street 1:3007 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2404
Practice Address - Country:US
Practice Address - Phone:718-777-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist