MEDICARE: ELIZABETH LIZA MARDAKHAEV

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	064756	NY

General Provider Information

NPI Number	:	1871078345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LIZA MARDAKHAEV

Provider Business Mailing Address
First Line	:	2790 W 5TH ST APT 13G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4126
Country	:	US
Telephone Number	:	646-318-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 E 7TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4801
Country	:	US
Telephone Number	:	718-921-8777
Fax Number	:

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

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	10/01/2018

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Directions to “ ELIZABETH LIZA MARDAKHAEV ” Practice Location

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