Provider Demographics
NPI:1467126045
Name:RABAYEV, JESSICA ESTELLE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ESTELLE
Last Name:RABAYEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 NE 170TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3070
Mailing Address - Country:US
Mailing Address - Phone:305-336-4818
Mailing Address - Fax:
Practice Address - Street 1:18320 COLLINS AVENUE
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2429
Practice Address - Country:US
Practice Address - Phone:305-914-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist