Basic Information
| Provider Information | |||||||||
| NPI: | 1407837222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUZAYLOV | ||||||||
| FirstName: | NELLY | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 WHITE AVE | ||||||||
| Address2: | FT HAMILTON | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112529503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186304268 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AINSWORTH US ARMY HEALTH CLINIC PHARMACY | ||||||||
| Address2: | AINSWORTH US ARMY HEALTH CLINIC BLDG 114 | ||||||||
| City: | FORT HAMILTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112526500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186304268 | ||||||||
| FaxNumber: | 7186304337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 06/25/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 045593-1 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.