Provider Demographics
NPI:1578886446
Name:ANIS, SYED YAWAR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:YAWAR
Last Name:ANIS
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 1:942 VAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1305
Mailing Address - Country:US
Mailing Address - Phone:718-546-7766
Mailing Address - Fax:
Practice Address - Street 1:1515 HAZEN ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1395
Practice Address - Country:US
Practice Address - Phone:718-546-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist