Individual
ALEKSANDR KHAITOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10005 ROOSEVELT AVE, CORONA, NY 11368
(718) 898-1100
(718) 898-1101
Mailing address
393 FRONT ST, HEMPSTEAD, NY 11550-4026
(516) 489-2211
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
058812
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058812
NEW YORK BOARD OF PHARMACY
NY
Enumeration date
01/10/2014
Last updated
08/28/2019
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