Provider Demographics
NPI:1871902973
Name:SELINGER, SERGEY
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:SELINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 64 AND 12
Mailing Address - Street 2:
Mailing Address - City:TSAILE
Mailing Address - State:AZ
Mailing Address - Zip Code:86556
Mailing Address - Country:US
Mailing Address - Phone:928-724-3643
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 64 AND 12
Practice Address - Street 2:
Practice Address - City:TSAILE
Practice Address - State:AZ
Practice Address - Zip Code:86556
Practice Address - Country:US
Practice Address - Phone:928-724-3643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03547000183500000X
FLPS 50365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist