Provider Demographics
NPI:1467149781
Name:MANIRUZZAMAN, MONIR
Entity Type:Individual
Prefix:
First Name:MONIR
Middle Name:
Last Name:MANIRUZZAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251A COMMONWEALTH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4775
Mailing Address - Country:US
Mailing Address - Phone:929-250-9757
Mailing Address - Fax:
Practice Address - Street 1:49 W FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5322
Practice Address - Country:US
Practice Address - Phone:718-733-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist