Provider Demographics
NPI:1831871995
Name:GRINCHUK, ALEKSANDR VLADIMIR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEKSANDR
Middle Name:VLADIMIR
Last Name:GRINCHUK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-7202
Mailing Address - Country:US
Mailing Address - Phone:941-468-6775
Mailing Address - Fax:
Practice Address - Street 1:2600 LAUREL RD E
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-3226
Practice Address - Country:US
Practice Address - Phone:941-261-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist