Provider Demographics
NPI:1861949919
Name:KIKOV, KIEFER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIEFER
Middle Name:
Last Name:KIKOV
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 1:6838 YELLOWSTONE BLVD
Mailing Address - Street 2:APT B54
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3417
Mailing Address - Country:US
Mailing Address - Phone:917-407-3104
Mailing Address - Fax:
Practice Address - Street 1:6838 YELLOWSTONE BLVD
Practice Address - Street 2:APT B54
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3417
Practice Address - Country:US
Practice Address - Phone:917-407-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist