Provider Demographics
NPI:1184947525
Name:BELOKON, DMITRI (RPH)
Entity type:Individual
Prefix:MR
First Name:DMITRI
Middle Name:
Last Name:BELOKON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5141
Mailing Address - Country:US
Mailing Address - Phone:718-975-8213
Mailing Address - Fax:
Practice Address - Street 1:492 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2013
Practice Address - Country:US
Practice Address - Phone:718-363-3300
Practice Address - Fax:718-363-2949
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046292OtherNY STATE PHARMACIST LICENSE NUMBER