Provider Demographics
NPI:1750605192
Name:BERKOVITS, DEBRA ROSE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ROSE
Last Name:BERKOVITS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4515
Mailing Address - Country:US
Mailing Address - Phone:718-436-6088
Mailing Address - Fax:718-436-3649
Practice Address - Street 1:5504 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4515
Practice Address - Country:US
Practice Address - Phone:718-436-6088
Practice Address - Fax:718-436-3649
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist