Provider Demographics
NPI:1902375454
Name:RETINSKIY, VENIAMIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VENIAMIN
Middle Name:
Last Name:RETINSKIY
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 1:107 SEATTLE TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5531
Mailing Address - Country:US
Mailing Address - Phone:386-334-6559
Mailing Address - Fax:
Practice Address - Street 1:80 PINNACLES DR STE 900
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2915
Practice Address - Country:US
Practice Address - Phone:386-313-5995
Practice Address - Fax:386-313-5996
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist