Provider Demographics
NPI:1205491602
Name:GAFAROV, SALIYA
Entity type:Individual
Prefix:
First Name:SALIYA
Middle Name:
Last Name:GAFAROV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1370
Mailing Address - Country:US
Mailing Address - Phone:717-747-4346
Mailing Address - Fax:
Practice Address - Street 1:3525 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1607
Practice Address - Country:US
Practice Address - Phone:675-365-0852
Practice Address - Fax:215-439-7977
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4525123336C0003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy