Provider Demographics
NPI:1366731028
Name:IMATDINOV, ERNEST (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:IMATDINOV
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 1:3380 NOSTRAND AVE APT 5K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4060
Mailing Address - Country:US
Mailing Address - Phone:347-925-5390
Mailing Address - Fax:
Practice Address - Street 1:3380 NOSTRAND AVE APT 5K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4060
Practice Address - Country:US
Practice Address - Phone:347-925-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03400700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist