Provider Demographics
NPI:1407188436
Name:BOK, IRINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:BOK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6401
Mailing Address - Country:US
Mailing Address - Phone:718-769-5777
Mailing Address - Fax:718-769-8080
Practice Address - Street 1:415 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6401
Practice Address - Country:US
Practice Address - Phone:718-769-5777
Practice Address - Fax:718-769-8080
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045459-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist