Provider Demographics
NPI:1659434942
Name:REHMAN, NISAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:NISAR
Middle Name:
Last Name:REHMAN
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 1:110 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4408
Mailing Address - Country:US
Mailing Address - Phone:516-294-4951
Mailing Address - Fax:718-843-3628
Practice Address - Street 1:11901 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2421
Practice Address - Country:US
Practice Address - Phone:718-843-8000
Practice Address - Fax:718-843-3628
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist