Provider Demographics
NPI:1285966382
Name:BIRZH, INNA
Entity type:Individual
Prefix:MRS
First Name:INNA
Middle Name:
Last Name:BIRZH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:INNA
Other - Middle Name:
Other - Last Name:BIRZH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:7724 NEW UTRECHT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1014
Mailing Address - Country:US
Mailing Address - Phone:718-236-1212
Mailing Address - Fax:718-236-1211
Practice Address - Street 1:7724 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1014
Practice Address - Country:US
Practice Address - Phone:718-236-1212
Practice Address - Fax:718-236-1211
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03084008Medicaid
NY6182870001Medicare NSC