Provider Demographics
NPI:1275245219
Name:TAHSIN, SHAFEN MOHAMMED (RPH)
Entity Type:Individual
Prefix:
First Name:SHAFEN
Middle Name:MOHAMMED
Last Name:TAHSIN
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 1:25111 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2425
Mailing Address - Country:US
Mailing Address - Phone:347-251-6932
Mailing Address - Fax:
Practice Address - Street 1:180 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4704
Practice Address - Country:US
Practice Address - Phone:516-442-5783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist