Provider Demographics
NPI:1366750911
Name:REZHETS, LARISSA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:
Last Name:REZHETS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165-15 ULIZA MAKSIMA GORKOGO
Mailing Address - Street 2:APT 2
Mailing Address - City:TASHKENT
Mailing Address - State:TASHKENT
Mailing Address - Zip Code:07770
Mailing Address - Country:UZ
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5313 5TH AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3110
Practice Address - Country:US
Practice Address - Phone:718-567-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist