Provider Demographics
NPI:1861089633
Name:LAVRICHENKO, MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LAVRICHENKO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 SHEEPSHEAD BAY RD PH 28D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3890
Mailing Address - Country:US
Mailing Address - Phone:347-326-1186
Mailing Address - Fax:
Practice Address - Street 1:88 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1510
Practice Address - Country:US
Practice Address - Phone:718-676-5413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist