Provider Demographics
NPI:1417074568
Name:YUSSOUF, QASIDA FATIMA (RPH)
Entity Type:Individual
Prefix:
First Name:QASIDA
Middle Name:FATIMA
Last Name:YUSSOUF
Suffix:
Gender:F
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 LENAPE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4647
Mailing Address - Country:US
Mailing Address - Phone:732-422-6889
Mailing Address - Fax:
Practice Address - Street 1:353 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3203
Practice Address - Country:US
Practice Address - Phone:718-467-0918
Practice Address - Fax:718-774-3078
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist