Provider Demographics
NPI:1649511395
Name:LAYLIEV, REBECCA (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LAYLIEV
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SHALOMOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1 OLD COUNTRY RD STE LL11
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1806
Mailing Address - Country:US
Mailing Address - Phone:516-287-2002
Mailing Address - Fax:
Practice Address - Street 1:1 OLD COUNTRY RD STE LL11
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1806
Practice Address - Country:US
Practice Address - Phone:516-287-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0578171183500000X
NY057817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacist