Provider Demographics
NPI:1982915773
Name:STAROSELETSKY, OLEG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:STAROSELETSKY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PENCE RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-4307
Mailing Address - Country:US
Mailing Address - Phone:718-690-6825
Mailing Address - Fax:
Practice Address - Street 1:3355 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1675
Practice Address - Country:US
Practice Address - Phone:718-372-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist