Provider Demographics
NPI:1619202835
Name:KHEYMAN, VYACHESLAV (PHARMD)
Entity Type:Individual
Prefix:
First Name:VYACHESLAV
Middle Name:
Last Name:KHEYMAN
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 1:8501 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4607
Mailing Address - Country:US
Mailing Address - Phone:718-238-1402
Mailing Address - Fax:
Practice Address - Street 1:8501 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4607
Practice Address - Country:US
Practice Address - Phone:718-238-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist