Provider Demographics
NPI:1083938179
Name:AHMAD, MALAK I (RPH)
Entity Type:Individual
Prefix:MR
First Name:MALAK
Middle Name:I
Last Name:AHMAD
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 1:5580 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1133
Mailing Address - Country:US
Mailing Address - Phone:917-304-4191
Mailing Address - Fax:
Practice Address - Street 1:23520 147TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3293
Practice Address - Country:US
Practice Address - Phone:718-978-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist