# 99-24 65RD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** mazol fatakhova
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225310923
- **Authorized official:** MISS MAZOL FATAKHOVA (PHARMACIST)
- **Authorized official phone:** 64678550774

## Contact information

- **Practice address:** 9924 65TH RD, REGO PARK, NY 11374-3655
- **Practice address phone:** (646) 785-5074
- **Mailing address:** 9924 65TH RD, REGO PARK, NY 11374-3655
- **Mailing address phone:** (646) 785-5074

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 20056294 | NY | Yes |

## Other

- **Enumeration date:** 09/19/2011
- **Last updated:** 09/19/2011