Provider Demographics
NPI:1134411580
Name:SHLAIN, ROLAN
Entity type:Individual
Prefix:
First Name:ROLAN
Middle Name:
Last Name:SHLAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 CROPSEY AVE
Mailing Address - Street 2:APT 11G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2740 CROPSEY AVE
Practice Address - Street 2:APT 11G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6849
Practice Address - Country:US
Practice Address - Phone:917-709-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist