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Individual

DR. ROMAN FAZYLOV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHARM.D.

Contact information

Practice address
800 2ND AVE, NEW YORK, NY 10017-4709
(646) 918-7363
Mailing address
15333 77TH AVE, FLUSHING, NY 11367-3127
(646) 519-0180

Taxonomy

Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
059235
NY

Other

Enumeration date
11/28/2015
Last updated
11/28/2015
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