Provider Demographics
NPI:1104095124
Name:GANAPOLSKY, NADEZHDA (RPH)
Entity type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:GANAPOLSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:NADEZHDA
Other - Middle Name:
Other - Last Name:VALKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1 GALLERIA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-3032
Mailing Address - Country:US
Mailing Address - Phone:845-692-3721
Mailing Address - Fax:845-692-3721
Practice Address - Street 1:1 GALLERIA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-3032
Practice Address - Country:US
Practice Address - Phone:845-692-3721
Practice Address - Fax:845-692-3721
Is Sole Proprietor?:No
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01652331Medicaid