Provider Demographics
NPI:1386042943
Name:SHAMSUDDIN, ARAFATH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ARAFATH
Middle Name:
Last Name:SHAMSUDDIN
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 1:3627 30TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3216
Mailing Address - Country:US
Mailing Address - Phone:347-666-8088
Mailing Address - Fax:
Practice Address - Street 1:3627 30TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3216
Practice Address - Country:US
Practice Address - Phone:347-666-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1059840-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1059840-1OtherLICENSE