Provider Demographics
NPI:1053867101
Name:RAHMAN, AHMED (PHARMD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:AHMED
Other - Middle Name:
Other - Last Name:ABD-ELRAHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3762 TERRAPIN PL
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3113
Mailing Address - Country:US
Mailing Address - Phone:631-255-5773
Mailing Address - Fax:
Practice Address - Street 1:3762 TERRAPIN PL
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3113
Practice Address - Country:US
Practice Address - Phone:631-255-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY61925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist