Healthcare Provider Details

I. General information

NPI: 1841476702
Provider Name (Legal Business Name): MILANA DZHURAYEVA PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22214 LINDEN BLVD
CAMBRIA HEIGHTS NY
11411-1606
US

IV. Provider business mailing address

13951 PERSHING CRES
JAMAICA NY
11435-1944
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-3000
  • Fax:
Mailing address:
  • Phone: 718-374-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number049824
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number049824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: