Provider Demographics
NPI:1629225073
Name:KULCHINSKAYA, VIKTORIY (RPH)
Entity Type:Individual
Prefix:
First Name:VIKTORIY
Middle Name:
Last Name:KULCHINSKAYA
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 1:176 GIFFORDS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2069
Mailing Address - Country:US
Mailing Address - Phone:917-470-5848
Mailing Address - Fax:
Practice Address - Street 1:1621 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5050
Practice Address - Country:US
Practice Address - Phone:718-498-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02664648Medicaid