Provider Demographics
NPI:1093009284
Name:IRSHAD, MOHAMMAD (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:IRSHAD
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 1:200 PORT RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1336
Mailing Address - Country:US
Mailing Address - Phone:718-816-1116
Mailing Address - Fax:718-816-1116
Practice Address - Street 1:200 PORT RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1336
Practice Address - Country:US
Practice Address - Phone:718-816-1116
Practice Address - Fax:718-816-1116
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist