Individual
MALKA FUZAILOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1239 E PUTNAM AVE, RIVERSIDE, CT 06878-1522
(203) 698-4006
Mailing address
1239 E PUTNAM AVE, RIVERSIDE, CT 06878-1522
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
061438
NY
183500000X
Pharmacist
Primary
PCT.0013526
CT
Other
Enumeration date
07/03/2016
Last updated
07/10/2016
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