Provider Demographics
NPI:1659694289
Name:BORUKHOV, JANET JANNA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:JANNA
Last Name:BORUKHOV
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 1:4709 217TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3512
Mailing Address - Country:US
Mailing Address - Phone:718-225-2113
Mailing Address - Fax:
Practice Address - Street 1:4748 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3334
Practice Address - Country:US
Practice Address - Phone:718-229-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047149-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist