Provider Demographics
NPI:1477030997
Name:OUSTAEV, ALAN ALEXANDER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ALEXANDER
Last Name:OUSTAEV
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 1:9707 63RD RD APT 3E
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1610
Mailing Address - Country:US
Mailing Address - Phone:917-435-9792
Mailing Address - Fax:
Practice Address - Street 1:60 ESSEX ST STE 105
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4347
Practice Address - Country:US
Practice Address - Phone:201-880-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03942700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03942700OtherNEW JERSEY BOARD OF PHARMACY LICENSE