Provider Demographics
NPI:1659438570
Name:SKOPOV, MARC A (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:A
Last Name:SKOPOV
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 TRENTON PLACE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962
Mailing Address - Country:US
Mailing Address - Phone:845-359-7420
Mailing Address - Fax:845-359-6718
Practice Address - Street 1:53 EAST 122ND STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2805
Practice Address - Country:US
Practice Address - Phone:212-369-5555
Practice Address - Fax:212-348-7891
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist