Provider Demographics
NPI:1972829273
Name:MOSHEYEV, RUSLAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RUSLAN
Middle Name:
Last Name:MOSHEYEV
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 1:1437 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1831
Mailing Address - Country:US
Mailing Address - Phone:917-992-3424
Mailing Address - Fax:
Practice Address - Street 1:9210 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1517
Practice Address - Country:US
Practice Address - Phone:718-835-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist