Provider Demographics
NPI:1386005205
Name:GROKHOTOV, ALEKSEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:GROKHOTOV
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1504
Mailing Address - Country:US
Mailing Address - Phone:781-596-9625
Mailing Address - Fax:781-595-4560
Practice Address - Street 1:43 STATE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1504
Practice Address - Country:US
Practice Address - Phone:781-596-9625
Practice Address - Fax:781-595-4560
Is Sole Proprietor?:No
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist