Provider Demographics
NPI:1619134012
Name:KAZMI, IMRAN S (RPH)
Entity Type:Individual
Prefix:MR
First Name:IMRAN
Middle Name:S
Last Name:KAZMI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24562 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2015
Mailing Address - Country:US
Mailing Address - Phone:212-567-1115
Mailing Address - Fax:212-567-1991
Practice Address - Street 1:232-A SHERMAN AVE
Practice Address - Street 2:SHERMAN PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-567-1115
Practice Address - Fax:212-567-1991
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044830-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044830-1OtherNY STATE LIC#