Provider Demographics
NPI:1093000770
Name:HASAN, QURATUL A (PHARM D)
Entity Type:Individual
Prefix:
First Name:QURATUL
Middle Name:A
Last Name:HASAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MASOOMA
Other - Middle Name:
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:328 E COMMERCIAL DR
Mailing Address - Street 2:STE 102-103
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:888-370-1724
Mailing Address - Fax:909-896-3774
Practice Address - Street 1:328 E COMMERCIAL DR
Practice Address - Street 2:STE 102-103
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:888-370-1724
Practice Address - Fax:909-896-3774
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 53149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist