Provider Demographics
NPI:1447563713
Name:LIPOVETSKIY, IGOR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:LIPOVETSKIY
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 1:5030 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034
Mailing Address - Country:US
Mailing Address - Phone:212-567-9800
Mailing Address - Fax:212-567-9805
Practice Address - Street 1:5030 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-567-9800
Practice Address - Fax:212-567-9805
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03267800183500000X
NY055141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist