Provider Demographics
NPI:1669795464
Name:GOLUBCHIN, SVETLANA (RPH)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:GOLUBCHIN
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 1:190 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2837
Mailing Address - Country:US
Mailing Address - Phone:201-693-3259
Mailing Address - Fax:
Practice Address - Street 1:589 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6346
Practice Address - Country:US
Practice Address - Phone:718-648-5999
Practice Address - Fax:718-769-4295
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042733-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist