Provider Demographics
NPI:1164989364
Name:ISRAILOVA, RIVEKA
Entity Type:Individual
Prefix:
First Name:RIVEKA
Middle Name:
Last Name:ISRAILOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIVEKA
Other - Middle Name:
Other - Last Name:ISRAILOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9841 65TH AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9841 65TH AVE APT 3D
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3437
Practice Address - Country:US
Practice Address - Phone:917-670-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist