Individual
MR. BORIS SEMENOVICH YAKUBOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9514 63RD DR, REGO PARK, NY 11374-2025
(718) 896-5084
(718) 896-1297
Mailing address
95-14 63RD DRIVE, REGO PARK, NY 11374
(718) 896-5084
(718) 896-1297
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
048454-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01562445
—
NY
Enumeration date
01/09/2008
Last updated
01/09/2008
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