Provider Demographics
NPI:1679746952
Name:SHAMALOV, MARINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SHAMALOV
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13214 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2915
Mailing Address - Country:US
Mailing Address - Phone:347-480-5103
Mailing Address - Fax:718-549-1422
Practice Address - Street 1:13214 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2915
Practice Address - Country:US
Practice Address - Phone:347-480-5103
Practice Address - Fax:718-549-1422
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist