Provider Demographics
NPI:1699183764
Name:NEKTALOV, MOISEY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MOISEY
Middle Name:
Last Name:NEKTALOV
Suffix:
Gender:
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 1:3147 LAWSON BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3717
Mailing Address - Country:US
Mailing Address - Phone:516-208-7332
Mailing Address - Fax:
Practice Address - Street 1:18116 69TH AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3524
Practice Address - Country:US
Practice Address - Phone:347-712-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist