Provider Demographics
NPI:1144645771
Name:GULYAMOV, SOLOMON (PHARMD)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:GULYAMOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3520
Mailing Address - Country:US
Mailing Address - Phone:718-435-5684
Mailing Address - Fax:718-435-9490
Practice Address - Street 1:5102 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3520
Practice Address - Country:US
Practice Address - Phone:718-435-5684
Practice Address - Fax:718-435-9490
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1057177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist