Provider Demographics
NPI:1861670796
Name:LEVIK, TATYANA (RPH)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:LEVIK
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 1:387 COLONY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5946
Mailing Address - Country:US
Mailing Address - Phone:718-667-5139
Mailing Address - Fax:718-332-2971
Practice Address - Street 1:387 COLONY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5946
Practice Address - Country:US
Practice Address - Phone:718-667-5139
Practice Address - Fax:718-332-2971
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist