Provider Demographics
NPI:1215259502
Name:SHAKHMUROV, MARIANA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:SHAKHMUROV
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 SAUNDERS ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2035
Mailing Address - Country:US
Mailing Address - Phone:718-570-6408
Mailing Address - Fax:
Practice Address - Street 1:4612 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1708
Practice Address - Country:US
Practice Address - Phone:718-570-6408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist