Provider Demographics
NPI:1821245267
Name:LIDUKHOVER, BORIS (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:
Last Name:LIDUKHOVER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3305
Mailing Address - Country:US
Mailing Address - Phone:718-482-0003
Mailing Address - Fax:718-482-1919
Practice Address - Street 1:3951 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3305
Practice Address - Country:US
Practice Address - Phone:718-482-0003
Practice Address - Fax:718-482-1919
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist