Provider Demographics
NPI:1609057280
Name:SIMKHOVICH, IRINA V (RPH)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:V
Last Name:SIMKHOVICH
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:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-1322
Mailing Address - Country:US
Mailing Address - Phone:845-744-8845
Mailing Address - Fax:845-744-8848
Practice Address - Street 1:2460 NY-52
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566
Practice Address - Country:US
Practice Address - Phone:845-744-8845
Practice Address - Fax:845-744-8848
Is Sole Proprietor?:No
Enumeration Date:2007-11-24
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY45480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00516409Medicaid