MEDICARE: RONA MISHIYEV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	069187	NY

General Provider Information

NPI Number	:	1255067740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONA MISHIYEV

Provider Business Mailing Address
First Line	:	10230 67TH AVE APT 2E
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2439
Country	:	US
Telephone Number	:	917-803-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	10230 67TH AVE APT 2E
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2439
Country	:	US
Telephone Number	:	917-803-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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Directions to “ RONA MISHIYEV ” Practice Location

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