Provider Demographics
NPI:1265842397
Name:CHOUDHURY, TANZINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANZINA
Middle Name:
Last Name:CHOUDHURY
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 1:10624 79TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1021
Mailing Address - Country:US
Mailing Address - Phone:313-729-1018
Mailing Address - Fax:
Practice Address - Street 1:10624 79TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1021
Practice Address - Country:US
Practice Address - Phone:313-729-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059012-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist