Provider Demographics
NPI:1396200226
Name:SHAMALOV, EFRAY
Entity Type:Individual
Prefix:
First Name:EFRAY
Middle Name:
Last Name:SHAMALOV
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 1:33 WALT WHITMAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3629
Mailing Address - Country:US
Mailing Address - Phone:631-350-6400
Mailing Address - Fax:631-350-6411
Practice Address - Street 1:33 WALT WHITMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3629
Practice Address - Country:US
Practice Address - Phone:631-350-6400
Practice Address - Fax:631-350-6411
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy