Provider Demographics
NPI:1336511633
Name:ANSARI, SHAIKH A SR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SHAIKH
Middle Name:A
Last Name:ANSARI
Suffix:SR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11119A ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-8032
Mailing Address - Country:US
Mailing Address - Phone:718-476-5660
Mailing Address - Fax:718-476-6768
Practice Address - Street 1:11119 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2625
Practice Address - Country:US
Practice Address - Phone:718-476-5660
Practice Address - Fax:718-476-6768
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist