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General NPI Number Information
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NPI Number | 1609240845
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Entity Type | Individual
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Provider Name | ROMAN FAZYLOV PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2015
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Last Update Date | 11/28/2015
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Provider Practice Location Address
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Address Line | 800 2ND AVE
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City | NEW YORK
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State | NY
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Zip | 10017-4709
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Country | US
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Telephone | 646-918-7363
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Fax |
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Provider Business Mailing Address
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Address Line | 15333 77TH AVE
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City | FLUSHING
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State | NY
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Zip | 11367-3127
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Country | US
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Telephone | 646-519-0180
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 059235
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License Number State | NY
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