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General NPI Number Information
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NPI Number | 1124894498
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Entity Type | Individual
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Provider Name | EVELYN LUCY FAZYLOVA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 11829 METROPOLITAN AVE
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City | KEW GARDENS
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State | NY
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Zip | 11415-2020
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Country | US
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Telephone | 718-487-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 15331 77TH RD
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City | FLUSHING
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State | NY
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Zip | 11367-3424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 071100
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License Number State | NY
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