Organization · NPI-2

99-24 65rd

Pharmacy · Rego Park, NY

NPI number1225310923
StatusActive
Last updated in NPPESSep 19, 2011

Details

NPI
1225310923
Entity type
Organization (NPI-2)
Legal business name
99-24 65rd
Organization subpart
No
Enumeration date
Sep 19, 2011
Last updated
Sep 19, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
333600000X Pharmacy20056294NYYes

Other names

  • Mazol Fatakhova (Other Name)

Practice location

9924 65th Rd
Rego Park, NY 11374-3655

Phone 646-785-5074

Mailing address

9924 65th Rd
Rego Park, NY 11374-3655

Phone 646-785-5074

Authorized official

Mazol Fatakhova
Pharmacist
64678550774

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