Provider Demographics
NPI:1477688455
Name:ISLAM, MOHAMMAD RAFIQUL
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:RAFIQUL
Last Name:ISLAM
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 1:34 FOXHURST RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4619
Mailing Address - Country:US
Mailing Address - Phone:631-549-1616
Mailing Address - Fax:631-549-1904
Practice Address - Street 1:8119 41ST AVE
Practice Address - Street 2:RUBEX DRUGS INC
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1300
Practice Address - Country:US
Practice Address - Phone:718-397-0776
Practice Address - Fax:718-898-8705
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist