Provider Demographics
NPI:1508594268
Name:FAYZAKOV, RUBEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:FAYZAKOV
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 1:6837 YELLOWSTONE BLVD APT D55
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3415
Mailing Address - Country:US
Mailing Address - Phone:347-414-4761
Mailing Address - Fax:
Practice Address - Street 1:99 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5511
Practice Address - Country:US
Practice Address - Phone:203-862-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist