Provider Demographics
NPI:1184091928
Name:KAGZANOV, ALEX (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:KAGZANOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ALEKSANDR
Other - Middle Name:S
Other - Last Name:KAGZANOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1494 OCEAN AVE # P1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4581
Mailing Address - Country:US
Mailing Address - Phone:718-570-3360
Mailing Address - Fax:718-228-3845
Practice Address - Street 1:1494 OCEAN AVE # P1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4581
Practice Address - Country:US
Practice Address - Phone:718-570-3360
Practice Address - Fax:718-228-3845
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist