Provider Demographics
NPI:1164749131
Name:GHAZALI, FARHEEN
Entity Type:Individual
Prefix:
First Name:FARHEEN
Middle Name:
Last Name:GHAZALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1047
Mailing Address - Country:US
Mailing Address - Phone:718-827-8943
Mailing Address - Fax:
Practice Address - Street 1:2981 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLY
Practice Address - State:NY
Practice Address - Zip Code:11208-1026
Practice Address - Country:US
Practice Address - Phone:718-827-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044601-1183500000X
NJ28RI02752400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist