Provider Demographics
NPI:1851456750
Name:GUREVICH, MARINA (RPH)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:GUREVICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1106
Mailing Address - Country:US
Mailing Address - Phone:718-232-8277
Mailing Address - Fax:718-232-8677
Practice Address - Street 1:217 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1106
Practice Address - Country:US
Practice Address - Phone:718-232-8277
Practice Address - Fax:718-232-8677
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02581491Medicaid
NY5143260001Medicare ID - Type Unspecified