MEDICARE: SALIYA GAFAROV

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	3336C0003X	Community/Retail Pharmacy	RP452512	PA
2	183500000X	Pharmacist	RP452512	PA

General Provider Information

NPI Number	:	1205491602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALIYA GAFAROV

Provider Business Mailing Address
First Line	:	108 HILLTOP DR
Second Line	:
City	:	CHURCHVILLE
State	:	PA
Zip	:	18966-1370
Country	:	US
Telephone Number	:	717-747-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1607
Country	:	US
Telephone Number	:	675-365-0852
Fax Number	:	215-439-7977

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

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	05/28/2025

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Directions to “ SALIYA GAFAROV ” Practice Location

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