Provider Demographics
NPI:1194109629
Name:ARUSTAMYAN, VLADISLAV (PHARM D)
Entity type:Individual
Prefix:DR
First Name:VLADISLAV
Middle Name:
Last Name:ARUSTAMYAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E 10TH ST APT 5K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2886
Mailing Address - Country:US
Mailing Address - Phone:917-213-4238
Mailing Address - Fax:
Practice Address - Street 1:3823 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2012
Practice Address - Country:US
Practice Address - Phone:718-743-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist