Organization
99-24 65RD
Active
Other names
mazol fatakhova
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MAZOL FATAKHOVA (PHARMACIST)
64678550774
Entity
Organization
Contact information
Practice address
9924 65TH RD, REGO PARK, NY 11374-3655
(646) 785-5074
Mailing address
9924 65TH RD, REGO PARK, NY 11374-3655
(646) 785-5074
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
20056294
NY
Other
Enumeration date
09/19/2011
Last updated
09/19/2011
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