Provider Demographics
NPI:1477928240
Name:BRAGARNIK, VIKTORIA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:VIKTORIA
Middle Name:
Last Name:BRAGARNIK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4801
Mailing Address - Country:US
Mailing Address - Phone:718-490-5707
Mailing Address - Fax:
Practice Address - Street 1:2801 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5449
Practice Address - Country:US
Practice Address - Phone:201-222-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03754000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist