Provider Demographics
NPI:1194219196
Name:AZAM, RUBINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RUBINA
Middle Name:
Last Name:AZAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1302
Mailing Address - Country:US
Mailing Address - Phone:516-241-4864
Mailing Address - Fax:
Practice Address - Street 1:18 HEATHER LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1302
Practice Address - Country:US
Practice Address - Phone:516-241-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist