MEDICARE: MAILKA IBRAGIMOVA RPH

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	054824	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	054824	OTHER	NY	STATE

General Provider Information

NPI Number	:	1649562935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAILKA IBRAGIMOVA RPH

Provider Business Mailing Address
First Line	:	6420 SAUNDERS ST
Second Line	:	APT # C 19
City	:	REGO PARK
State	:	NY
Zip	:	11374
Country	:	US
Telephone Number	:	917-318-6708
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3702
Country	:	US
Telephone Number	:	917-318-6708
Fax Number	:

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

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	05/05/2011

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