Provider Demographics
NPI:1154645315
Name:MOMIN, SYED HASAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:HASAN
Last Name:MOMIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 SOUTHERN BLVD
Mailing Address - Street 2:TU FARMACIA INC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3762
Mailing Address - Country:US
Mailing Address - Phone:718-292-8513
Mailing Address - Fax:718-292-5246
Practice Address - Street 1:553 SOUTHERN BLVD
Practice Address - Street 2:TU FARMACIA INC
Practice Address - City:BRONX NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10455-3762
Practice Address - Country:US
Practice Address - Phone:718-292-8513
Practice Address - Fax:718-292-5246
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist