Provider Demographics
NPI:1295054286
Name:GABRIYELOV, ALEKSEY
Entity type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:GABRIYELOV
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 1:414 NEWGATE CT
Mailing Address - Street 2:APT. A 2
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7769
Mailing Address - Country:US
Mailing Address - Phone:267-266-9921
Mailing Address - Fax:
Practice Address - Street 1:4000 WOODHAVEN RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-2810
Practice Address - Country:US
Practice Address - Phone:215-637-7840
Practice Address - Fax:215-637-2232
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist