Provider Demographics
NPI:1538483110
Name:ANSARI, IMDAD A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:IMDAD
Middle Name:A
Last Name:ANSARI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W 181ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5101
Mailing Address - Country:US
Mailing Address - Phone:212-740-3737
Mailing Address - Fax:
Practice Address - Street 1:522 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5101
Practice Address - Country:US
Practice Address - Phone:212-740-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032337-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist