Provider Demographics
NPI:1205308202
Name:MINAROVICOVA, DENISA (PHARMDR)
Entity type:Individual
Prefix:MRS
First Name:DENISA
Middle Name:
Last Name:MINAROVICOVA
Suffix:
Gender:F
Credentials:PHARMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 69TH PL FL 1
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1432
Mailing Address - Country:US
Mailing Address - Phone:646-203-4572
Mailing Address - Fax:
Practice Address - Street 1:6515 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3332
Practice Address - Country:US
Practice Address - Phone:718-366-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI061774-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist