Provider Demographics
NPI:1376251694
Name:BORUKHOVA, NATELLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATELLA
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 1:7110 PARK AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4108
Mailing Address - Country:US
Mailing Address - Phone:602-710-4271
Mailing Address - Fax:
Practice Address - Street 1:10709 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6820
Practice Address - Country:US
Practice Address - Phone:917-410-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024447183500000X
NY068861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist