Provider Demographics
NPI:1306154042
Name:CHEMERISOV, GLEB (PHARMD)
Entity type:Individual
Prefix:MR
First Name:GLEB
Middle Name:
Last Name:CHEMERISOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:GLEB
Other - Middle Name:
Other - Last Name:CHEMERISOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:440 NEPTUNE AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 NEPTUNE AVE APT 3E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4625
Practice Address - Country:US
Practice Address - Phone:718-437-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist