Provider Demographics
NPI:1295015006
Name:RAFAELOV, NATAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:NATAN
Middle Name:
Last Name:RAFAELOV
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5002
Mailing Address - Country:US
Mailing Address - Phone:516-433-2711
Mailing Address - Fax:516-681-6422
Practice Address - Street 1:210 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5002
Practice Address - Country:US
Practice Address - Phone:516-433-2711
Practice Address - Fax:516-681-6422
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist