Provider Demographics
NPI:1306667993
Name:GADAYEVA, JENNIFER (RPH)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:GADAYEVA
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 1:9834 63RD DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2305
Mailing Address - Country:US
Mailing Address - Phone:646-301-1493
Mailing Address - Fax:
Practice Address - Street 1:9834 63RD DR APT 2B
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2305
Practice Address - Country:US
Practice Address - Phone:646-301-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist