Malka Fuzailov
Individual provider Active NPI Pharmacist · Riverside, CT
NPI 1003268939 · NPPES record last updated Jul 10, 2016
Key facts
- NPI
- 1003268939
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PCT.0013526 (CT)
- Practice address
- 1239 E Putnam Ave
Riverside, CT 06878-1522 - Phone
- (203) 698-4006
- NPI assigned
- Jul 3, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0013526 | CT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 061438 | NY | |
| Pharmacist | 183500000X | PCT.0013526 | CT | Yes |
Addresses
Primary practice location
1239 E Putnam Ave
Riverside, CT 06878-1522
Mailing address
1239 E Putnam Ave
Riverside, CT 06878-1522
Other providers in Riverside, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.