Provider Demographics
NPI:1063999829
Name:DAVYDOV, MEYER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MEYER
Middle Name:
Last Name:DAVYDOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MEYER
Other - Middle Name:
Other - Last Name:DAVIDOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9611 65TH RD APT 105
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4107
Mailing Address - Country:US
Mailing Address - Phone:347-437-9341
Mailing Address - Fax:
Practice Address - Street 1:60 ESSEX ST STE 105
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4347
Practice Address - Country:US
Practice Address - Phone:201-880-7000
Practice Address - Fax:201-880-7094
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03942200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist