Provider Demographics
NPI:1417054115
Name:DASTGIR, GHULAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:GHULAM
Middle Name:
Last Name:DASTGIR
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 1:318 DIX HILLS RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7825
Mailing Address - Country:US
Mailing Address - Phone:631-271-0127
Mailing Address - Fax:
Practice Address - Street 1:318 DIX HILLS RD
Practice Address - Street 2:DIX HILLS
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7825
Practice Address - Country:US
Practice Address - Phone:631-271-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist