Provider Demographics
NPI:1538311790
Name:MIRZA, AMARA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:AMARA
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OLD COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1229
Mailing Address - Country:US
Mailing Address - Phone:347-693-6130
Mailing Address - Fax:
Practice Address - Street 1:20 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1229
Practice Address - Country:US
Practice Address - Phone:347-693-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist