Provider Demographics
NPI:1801371091
Name:GORNOSTAY, OLGA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:GORNOSTAY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BEDFORD AVE APT 10N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2661
Mailing Address - Country:US
Mailing Address - Phone:917-535-3595
Mailing Address - Fax:
Practice Address - Street 1:1700 BEDFORD AVE APT 10N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2661
Practice Address - Country:US
Practice Address - Phone:917-535-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI064476-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist