Provider Demographics
NPI:1366675340
Name:FAHAD, SYED (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:FAHAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2509
Mailing Address - Country:US
Mailing Address - Phone:516-887-5128
Mailing Address - Fax:
Practice Address - Street 1:77 GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1008
Practice Address - Country:US
Practice Address - Phone:516-887-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist