Provider Demographics
NPI:1346572336
Name:RAHMAN, MOHAMMED (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:RAHMAN
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 1:348 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1343
Mailing Address - Country:US
Mailing Address - Phone:516-442-4995
Mailing Address - Fax:516-442-4998
Practice Address - Street 1:500 COMMACK RD STE 100A
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5020
Practice Address - Country:US
Practice Address - Phone:631-486-9898
Practice Address - Fax:631-486-9895
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050702OtherPHARMACIST LIC