Provider Demographics
NPI:1851418750
Name:SALENKO, JAROSLAV V (RPH)
Entity Type:Individual
Prefix:
First Name:JAROSLAV
Middle Name:V
Last Name:SALENKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 ENDICOTT PLZ
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5047
Mailing Address - Country:US
Mailing Address - Phone:607-754-3585
Mailing Address - Fax:607-754-3536
Practice Address - Street 1:527 ENDICOTT PLZ
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5047
Practice Address - Country:US
Practice Address - Phone:607-754-3585
Practice Address - Fax:607-754-3536
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist