Provider Demographics
NPI:1215252309
Name:KAMINSKY, ELINA (RPH)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:KAMINSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ELINA
Other - Middle Name:
Other - Last Name:KAMINKSY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:117 BARLOW DR S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6721
Mailing Address - Country:US
Mailing Address - Phone:718-265-4646
Mailing Address - Fax:718-265-1406
Practice Address - Street 1:1853 CROPSEY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6035
Practice Address - Country:US
Practice Address - Phone:718-265-4646
Practice Address - Fax:718-265-1406
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02420991Medicaid
NY02420991Medicaid