Provider Demographics
NPI:1508907668
Name:AHMED, SHADI (PHARMD, CCP, RPH)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:PHARMD, CCP, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BOLIVAR ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5604
Mailing Address - Country:US
Mailing Address - Phone:718-494-6077
Mailing Address - Fax:
Practice Address - Street 1:95 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3824
Practice Address - Country:US
Practice Address - Phone:732-346-1333
Practice Address - Fax:732-346-1999
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02998400183500000X
NY20 051353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist