Provider Demographics
NPI:1538619564
Name:PISAREVSKY, YEVA (RPH)
Entity type:Individual
Prefix:
First Name:YEVA
Middle Name:
Last Name:PISAREVSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 61ST ST
Mailing Address - Street 2:#1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2652
Mailing Address - Country:US
Mailing Address - Phone:718-614-7468
Mailing Address - Fax:
Practice Address - Street 1:1416 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2004
Practice Address - Country:US
Practice Address - Phone:718-375-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045827-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist