Provider Demographics
NPI:1285966978
Name:ZAVULUNOV, STANISLAV (RPH)
Entity type:Individual
Prefix:MR
First Name:STANISLAV
Middle Name:
Last Name:ZAVULUNOV
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 1:11821 QUEENS BLVD STE 608
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7206
Mailing Address - Country:US
Mailing Address - Phone:347-535-5333
Mailing Address - Fax:347-535-5334
Practice Address - Street 1:11821 QUEENS BLVD STE 608
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7206
Practice Address - Country:US
Practice Address - Phone:347-535-5333
Practice Address - Fax:347-535-5334
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist