Active NPI
Mikhail R Gavrilov, RPH
- Pharmacist
- Woodhaven, NY
National Provider Identifier
1356673818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 044749
- Practice address
- 9602 Jamaica Ave
Woodhaven, NY 11421-2209 - Phone
- (718) 805-7000
- Fax
- (718) 805-0257
- NPI assigned
- Feb 9, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 044749 | NY | Primary |
Addresses
Primary practice location
9602 Jamaica Ave
Woodhaven, NY 11421-2209
Mailing address
9952 64TH Rd
Rego Park, NY 11374-2646
Phone (917) 325-2150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044749 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| M & a Pharmacy Corp | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265673600000",
"number": "1356673818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9952 64TH RD",
"city": "REGO PARK",
"state": "NY",
"postal_code": "113742646",
"telephone_number": "917-325-2150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9602 JAMAICA AVE",
"city": "WOODHAVEN",
"state": "NY",
"postal_code": "114212209",
"telephone_number": "718-805-7000",
"fax_number": "718-805-0257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVRILOV",
"first_name": "MIKHAIL",
"middle_name": "R",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-09",
"last_updated": "2010-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "044749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodhaven, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.