Provider Demographics
NPI:1124394010
Name:MIRZA, FARIHA (RPH)
Entity Type:Individual
Prefix:
First Name:FARIHA
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 LANGDALE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1821
Mailing Address - Country:US
Mailing Address - Phone:516-424-3766
Mailing Address - Fax:718-777-8545
Practice Address - Street 1:8250 LANGDALE ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1821
Practice Address - Country:US
Practice Address - Phone:516-424-3766
Practice Address - Fax:718-777-8545
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist