MEDICARE: DR. INNA FAYFMAN PHARM D

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	1835P1200X	Pharmacotherapy Pharmacist	049642	NY

General Provider Information

NPI Number	:	1538320973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INNA FAYFMAN PHARM D

Provider Business Mailing Address
First Line	:	7502 RIDGE BLVD, F-4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1305
Country	:	US
Telephone Number	:	917-583-2692
Fax Number	:

Provider Business Practice Location Address
First Line	:	7502 RIDGE BLVD APT F4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2948
Country	:	US
Telephone Number	:	917-583-2692
Fax Number	:

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	09/18/2008

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