Provider Demographics
NPI:1952683971
Name:BABAKHANOV, ALEKSANDER (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALEKSANDER
Middle Name:
Last Name:BABAKHANOV
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 63RD RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1348
Mailing Address - Country:US
Mailing Address - Phone:347-247-9255
Mailing Address - Fax:
Practice Address - Street 1:373 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5033
Practice Address - Country:US
Practice Address - Phone:718-220-2111
Practice Address - Fax:718-220-2112
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20056058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist