Provider Demographics
NPI:1780810200
Name:SEMENOV, SERGEY (PHARMD, RPH, MPH)
Entity type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:
Last Name:SEMENOV
Suffix:
Gender:M
Credentials:PHARMD, RPH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 AVENUE Z
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4301
Mailing Address - Country:US
Mailing Address - Phone:917-933-4000
Mailing Address - Fax:917-933-4004
Practice Address - Street 1:1201 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4301
Practice Address - Country:US
Practice Address - Phone:917-933-4000
Practice Address - Fax:917-933-4004
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048741OtherLICENSE