Provider Demographics
NPI:1942062930
Name:PEVZNER, BEATRICE
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:PEVZNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 W 5TH ST APT 19B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4805
Mailing Address - Country:US
Mailing Address - Phone:347-791-5098
Mailing Address - Fax:
Practice Address - Street 1:2932 W 5TH ST APT 19B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4805
Practice Address - Country:US
Practice Address - Phone:347-791-5098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist