Provider Demographics
NPI:1104953496
Name:BURAKOVSKIY, ALLA (RPH)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:BURAKOVSKIY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:153 MACKENZIE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2303
Mailing Address - Country:US
Mailing Address - Phone:347-254-6381
Mailing Address - Fax:
Practice Address - Street 1:153 MACKENZIE ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2303
Practice Address - Country:US
Practice Address - Phone:347-254-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00068158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist