Provider Demographics
NPI:1942644612
Name:FUZAYLOV, LEV (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LEV
Middle Name:
Last Name:FUZAYLOV
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:LEV
Other - Middle Name:
Other - Last Name:FUZAYLOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2701 OCEAN AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:646-286-1036
Mailing Address - Fax:
Practice Address - Street 1:2701 OCEAN AVE APT 6A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4619
Practice Address - Country:US
Practice Address - Phone:646-286-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist