Provider Demographics
NPI:1518282425
Name:MURTAZA, GHULAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:GHULAM
Middle Name:
Last Name:MURTAZA
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 1:182 LODGE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2830
Mailing Address - Country:US
Mailing Address - Phone:631-988-0165
Mailing Address - Fax:
Practice Address - Street 1:642 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4113
Practice Address - Country:US
Practice Address - Phone:718-346-9512
Practice Address - Fax:718-346-7059
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist