Healthcare Provider Details

I. General information

NPI: 1437707635
Provider Name (Legal Business Name): NATAVAN REZAKOVA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 GRAVESEND NECK RD FL 2
BROOKLYN NY
11229-4510
US

IV. Provider business mailing address

1809 GRAVESEND NECK RD FL 2
BROOKLYN NY
11229-4510
US

V. Phone/Fax

Practice location:
  • Phone: 347-681-6453
  • Fax:
Mailing address:
  • Phone: 347-681-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: