Provider Demographics
NPI:1366611154
Name:MULOKANDOV, ABO
Entity type:Individual
Prefix:
First Name:ABO
Middle Name:
Last Name:MULOKANDOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 AGUILAR AVE
Mailing Address - Street 2:APT. 4C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2731
Mailing Address - Country:US
Mailing Address - Phone:718-380-3704
Mailing Address - Fax:718-641-3530
Practice Address - Street 1:9210 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1517
Practice Address - Country:US
Practice Address - Phone:718-835-7903
Practice Address - Fax:718-641-3530
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052174OtherRPH