Provider Demographics
NPI:1619265873
Name:BEREZOVSKAYA, IRINA (RPH)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BEREZOVSKAYA
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 1:9 W BROADWAY UNIT 515
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1060
Mailing Address - Country:US
Mailing Address - Phone:617-833-5177
Mailing Address - Fax:
Practice Address - Street 1:158 LEWIS ST
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902
Practice Address - Country:US
Practice Address - Phone:781-592-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist