Provider Demographics
NPI:1952964108
Name:GERSHTEYN, INESSA
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:GERSHTEYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3438
Mailing Address - Country:US
Mailing Address - Phone:303-200-1492
Mailing Address - Fax:303-200-1493
Practice Address - Street 1:10755 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-3438
Practice Address - Country:US
Practice Address - Phone:303-200-1492
Practice Address - Fax:303-200-1493
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist