Provider Demographics
NPI:1164679171
Name:HOSSAIN, MAHMUD (RPH)
Entity Type:Individual
Prefix:
First Name:MAHMUD
Middle Name:
Last Name:HOSSAIN
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 1:7432 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5609
Mailing Address - Country:US
Mailing Address - Phone:718-426-4080
Mailing Address - Fax:718-426-1213
Practice Address - Street 1:7432 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5609
Practice Address - Country:US
Practice Address - Phone:718-426-4080
Practice Address - Fax:718-426-1213
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist