Provider Demographics
NPI:1306020052
Name:RAMADAN, MARTHAHALL (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:MARTHAHALL
Middle Name:
Last Name:RAMADAN
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1902
Mailing Address - Country:US
Mailing Address - Phone:718-433-0941
Mailing Address - Fax:718-349-2575
Practice Address - Street 1:4502 43RD AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1902
Practice Address - Country:US
Practice Address - Phone:718-592-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477036Medicaid