Provider Demographics
NPI:1386820728
Name:ISMAIL, FAREED (RPH)
Entity Type:Individual
Prefix:MR
First Name:FAREED
Middle Name:
Last Name:ISMAIL
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 1:17 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2701
Mailing Address - Country:US
Mailing Address - Phone:518-434-6024
Mailing Address - Fax:518-626-0859
Practice Address - Street 1:17 N PEARL ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2701
Practice Address - Country:US
Practice Address - Phone:518-434-6024
Practice Address - Fax:518-626-0859
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1542561Medicaid