Provider Demographics
NPI:1699224451
Name:BLAZHKO, MARINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BLAZHKO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 OCEAN PKWY # 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7813
Mailing Address - Country:US
Mailing Address - Phone:718-724-2245
Mailing Address - Fax:
Practice Address - Street 1:749 OCEAN PKWY # 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7813
Practice Address - Country:US
Practice Address - Phone:718-724-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist