Provider Demographics
NPI:1568712206
Name:RATTU, MOHAMMAD AWAIS (PHARMD,BCOP,BCPS,CGP)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:AWAIS
Last Name:RATTU
Suffix:
Gender:M
Credentials:PHARMD,BCOP,BCPS,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-241-1509
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31517921835P1200X
NY51508321835X0200X
NY057096183500000X
NY91039961835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835X0200XPharmacy Service ProvidersPharmacistOncology
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric