Provider Demographics
NPI:1407273097
Name:SIVKOV, ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:SIVKOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CORBIN PL APT 2P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4833
Mailing Address - Country:US
Mailing Address - Phone:646-338-8112
Mailing Address - Fax:
Practice Address - Street 1:150 CORBIN PL APT 2P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4833
Practice Address - Country:US
Practice Address - Phone:646-338-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 51384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist