Provider Demographics
NPI:1689295974
Name:PAKHOLSKIY, ANDREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:PAKHOLSKIY
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 1:515 INMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067
Mailing Address - Country:US
Mailing Address - Phone:732-381-3400
Mailing Address - Fax:732-381-3464
Practice Address - Street 1:515 INMAN AVENUE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067
Practice Address - Country:US
Practice Address - Phone:732-381-3400
Practice Address - Fax:732-381-3464
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03908900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty