Provider Demographics
NPI:1497077846
Name:FUZAYLOV, BORIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:FUZAYLOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 QUEENS BLVD APT 5S
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2460
Mailing Address - Country:US
Mailing Address - Phone:718-490-9359
Mailing Address - Fax:
Practice Address - Street 1:7505 NW 71ST TER
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-3947
Practice Address - Country:US
Practice Address - Phone:718-490-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053106183500000X
FL64037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist