Provider Demographics
NPI:1891943874
Name:RAYTBURG, DMITRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:DMITRY
Middle Name:
Last Name:RAYTBURG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1478
Mailing Address - Country:US
Mailing Address - Phone:718-753-4900
Mailing Address - Fax:718-753-4939
Practice Address - Street 1:342 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1478
Practice Address - Country:US
Practice Address - Phone:718-753-4900
Practice Address - Fax:718-753-4939
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist