Provider Demographics
NPI:1215190046
Name:MOHAN, NIDHIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:NIDHIN
Middle Name:
Last Name:MOHAN
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 1:876 CONNETQUOT AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1425
Mailing Address - Country:US
Mailing Address - Phone:631-581-5496
Mailing Address - Fax:631-581-1268
Practice Address - Street 1:876 CONNETQUOT AVE
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1425
Practice Address - Country:US
Practice Address - Phone:631-581-5496
Practice Address - Fax:631-581-1268
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist