Provider Demographics
NPI:1164746327
Name:RAHMAN, MUHAMMAD ATIQUR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:ATIQUR
Last Name:RAHMAN
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:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-0626
Mailing Address - Country:US
Mailing Address - Phone:845-626-0900
Mailing Address - Fax:845-626-5546
Practice Address - Street 1:6401 ROUTE 209
Practice Address - Street 2:
Practice Address - City:KERHONKSON
Practice Address - State:NY
Practice Address - Zip Code:12446-3033
Practice Address - Country:US
Practice Address - Phone:845-626-0900
Practice Address - Fax:845-626-5546
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
NY045158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045158OtherTHE UNIVERSITY OF THE STATE OF NEW YORK/ EDUCATION DEPARTMENT