Provider Demographics
NPI:1548605611
Name:ELBASHA, ALI MOHAMED (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:MOHAMED
Last Name:ELBASHA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 GLENWOOD RD
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2632
Mailing Address - Country:US
Mailing Address - Phone:734-883-3529
Mailing Address - Fax:
Practice Address - Street 1:5015 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4458
Practice Address - Country:US
Practice Address - Phone:718-426-7572
Practice Address - Fax:718-426-7805
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI057728-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist