Provider Demographics
NPI:1518641489
Name:MAHBOOB, MUHTASIM (RPH)
Entity Type:Individual
Prefix:
First Name:MUHTASIM
Middle Name:
Last Name:MAHBOOB
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 1:9012 VANDERVEER ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1240
Mailing Address - Country:US
Mailing Address - Phone:718-288-3524
Mailing Address - Fax:
Practice Address - Street 1:570 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5049
Practice Address - Country:US
Practice Address - Phone:802-860-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist