Provider Demographics
NPI:1578960605
Name:FAILAEV, AVRAHAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AVRAHAM
Middle Name:
Last Name:FAILAEV
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 1:408 E NORTH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2332
Mailing Address - Country:US
Mailing Address - Phone:443-859-3613
Mailing Address - Fax:
Practice Address - Street 1:408 E NORTH POINTE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2332
Practice Address - Country:US
Practice Address - Phone:443-859-3613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist