Provider Demographics
NPI:1407837222
Name:FUZAYLOV, NELLY (RPH)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:FUZAYLOV
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WHITE AVE
Mailing Address - Street 2:FT HAMILTON
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11252-9503
Mailing Address - Country:US
Mailing Address - Phone:718-630-4268
Mailing Address - Fax:
Practice Address - Street 1:AINSWORTH US ARMY HEALTH CLINIC PHARMACY
Practice Address - Street 2:AINSWORTH US ARMY HEALTH CLINIC BLDG 114
Practice Address - City:FORT HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:11252-6500
Practice Address - Country:US
Practice Address - Phone:718-630-4268
Practice Address - Fax:718-630-4337
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045593-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist