MEDICARE: NATAVAN REZAKOVA PHARMD

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	183500000X	Pharmacist	065952	NY

General Provider Information

NPI Number	:	1437707635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATAVAN REZAKOVA PHARMD

Provider Business Mailing Address
First Line	:	1809 GRAVESEND NECK RD FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4510
Country	:	US
Telephone Number	:	347-681-6453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 GRAVESEND NECK RD FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4510
Country	:	US
Telephone Number	:	347-681-6453
Fax Number	:

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

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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