Provider Demographics
NPI:1154596070
Name:BLUSTIN, MARAT (RPH)
Entity type:Individual
Prefix:
First Name:MARAT
Middle Name:
Last Name:BLUSTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4523
Mailing Address - Country:US
Mailing Address - Phone:917-922-3204
Mailing Address - Fax:718-648-4328
Practice Address - Street 1:2617 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3801
Practice Address - Country:US
Practice Address - Phone:718-648-4441
Practice Address - Fax:718-648-4328
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist