Provider Demographics
NPI:1093452138
Name:MIAH, RAZWAN (RPH)
Entity Type:Individual
Prefix:
First Name:RAZWAN
Middle Name:
Last Name:MIAH
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 1:9151 195TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3501
Mailing Address - Country:US
Mailing Address - Phone:347-635-9401
Mailing Address - Fax:
Practice Address - Street 1:17 MARCUS GARVEY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5335
Practice Address - Country:US
Practice Address - Phone:718-218-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist