MEDICARE: DR. EDUARD ISRAILOV PHARMD

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	0662522	NY

General Provider Information

NPI Number	:	1730622093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARD ISRAILOV PHARMD

Provider Business Mailing Address
First Line	:	22417A UNION TPKE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-3631
Country	:	US
Telephone Number	:	718-749-5024
Fax Number	:

Provider Business Practice Location Address
First Line	:	22417A UNION TPKE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-3631
Country	:	US
Telephone Number	:	718-749-5024
Fax Number	:

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

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	09/14/2020

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