Provider Demographics
NPI:1639522048
Name:MANZOOR, MOHAMMED KASIM I (PHARM D)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:KASIM
Last Name:MANZOOR
Suffix:I
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 CLIFFSIDE DR
Mailing Address - Street 2:UNIT E
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3481
Mailing Address - Country:US
Mailing Address - Phone:860-930-0768
Mailing Address - Fax:
Practice Address - Street 1:70 CLIFFSIDE DR
Practice Address - Street 2:UNIT E
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3481
Practice Address - Country:US
Practice Address - Phone:860-930-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist