Provider Demographics
NPI:1477851152
Name:YERUKHIMOVICH, MIKHAIL Y (R PH)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:Y
Last Name:YERUKHIMOVICH
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 14TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4652
Mailing Address - Country:US
Mailing Address - Phone:718-545-1937
Mailing Address - Fax:
Practice Address - Street 1:3355 14TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4652
Practice Address - Country:US
Practice Address - Phone:718-545-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist