Provider Demographics
NPI:1154644151
Name:ISLAM, SHAHEDA (PHARMD,RPH)
Entity Type:Individual
Prefix:
First Name:SHAHEDA
Middle Name:
Last Name:ISLAM
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3201
Mailing Address - Country:US
Mailing Address - Phone:718-937-6990
Mailing Address - Fax:
Practice Address - Street 1:3543 28TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-3201
Practice Address - Country:US
Practice Address - Phone:718-937-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist