Provider Demographics
NPI:1962816306
Name:KAGAN, ANATOLIY
Entity Type:Individual
Prefix:
First Name:ANATOLIY
Middle Name:
Last Name:KAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8445 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2400
Mailing Address - Country:US
Mailing Address - Phone:215-333-0535
Mailing Address - Fax:215-333-6039
Practice Address - Street 1:8445 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2400
Practice Address - Country:US
Practice Address - Phone:215-333-0535
Practice Address - Fax:215-333-6039
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441561183500000X
IL051.293206183500000X
KY015239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist