Provider Demographics
NPI:1114362704
Name:CHEPKUNOV, ARKADY BORISOVICH (RPH)
Entity type:Individual
Prefix:
First Name:ARKADY
Middle Name:BORISOVICH
Last Name:CHEPKUNOV
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W ROUTE 59
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2221
Mailing Address - Country:US
Mailing Address - Phone:845-507-0630
Mailing Address - Fax:845-507-0631
Practice Address - Street 1:250 W ROUTE 59
Practice Address - Street 2:SUITE 5
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2221
Practice Address - Country:US
Practice Address - Phone:845-507-0630
Practice Address - Fax:845-507-0631
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist