Active NPI
Ruben Fayzakov, PHARMD
- Pharmacist
- Greenwich, CT
National Provider Identifier
1508594268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PCT.0015804
- Practice address
- 99 Greenwich Ave
Greenwich, CT 06830-5511 - Phone
- (203) 862-9320
- NPI assigned
- Aug 10, 2022
- Last updated
- Aug 10, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 | PCT.0015804 | CT | Primary |
Addresses
Primary practice location
99 Greenwich Ave
Greenwich, CT 06830-5511
Mailing address
6837 Yellowstone Blvd Apt D55
Forest Hills, NY 11375-3415
Phone (347) 414-4761
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | CVS | Direct |
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0015804 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Shore RX Inc | Current | Accepting new patients | |
| Connecticut CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Connecticut CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Community/Retail Pharmacy
- Manhasset, NY
- NPI 1427905207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660089600000",
"number": "1508594268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6837 YELLOWSTONE BLVD APT D55",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113753415",
"telephone_number": "347-414-4761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 GREENWICH AVE",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068305511",
"telephone_number": "203-862-9320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAYZAKOV",
"first_name": "RUBEN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-10",
"last_updated": "2022-08-10",
"certification_date": "2022-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "PCT.0015804",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "CVS",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "99 Greenwich Ave",
"city": "Greenwich",
"state": "CT",
"country_code": "US",
"postal_code": "068305511",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Greenwich, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.