Provider Demographics
NPI:1194350751
Name:ALISHAYEVA, ALLA (RPH)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:ALISHAYEVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 108TH ST APT A11
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8906
Mailing Address - Country:US
Mailing Address - Phone:347-484-7038
Mailing Address - Fax:
Practice Address - Street 1:6836 108TH ST APT A11
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8906
Practice Address - Country:US
Practice Address - Phone:347-484-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist