Provider Demographics
NPI:1326296302
Name:AHMED, SHAHAB (MPHARM)
Entity Type:Individual
Prefix:MR
First Name:SHAHAB
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PIRONI CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1229
Mailing Address - Country:US
Mailing Address - Phone:718-392-8049
Mailing Address - Fax:718-729-0165
Practice Address - Street 1:3012 36TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-2315
Practice Address - Country:US
Practice Address - Phone:718-392-8049
Practice Address - Fax:718-729-0165
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033930OtherNEW YORK STATE PHARMACIST LICENSE NUMBER