Provider Demographics
NPI:1982972733
Name:YERMAKOV, MAKSIM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAKSIM
Middle Name:
Last Name:YERMAKOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 35TH AVE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5424
Mailing Address - Country:US
Mailing Address - Phone:954-989-6300
Mailing Address - Fax:954-989-5457
Practice Address - Street 1:1150 NORTH 35TH AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-989-6300
Practice Address - Fax:954-989-5457
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist