Provider Demographics
NPI:1912221870
Name:ABDURAKHMANOV, MAZOL (PHARM D)
Entity Type:Individual
Prefix:
First Name:MAZOL
Middle Name:
Last Name:ABDURAKHMANOV
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:ABDURAKHMANOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80-09 37 AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-533-6623
Mailing Address - Fax:
Practice Address - Street 1:80-09 37 AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-533-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048314OtherN.Y. STATE LICENSE