Provider Demographics
NPI:1659453470
Name:SARFRAZ, MOHAMMAD AZIM (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AZIM
Last Name:SARFRAZ
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 1:45-60 43RD ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104
Mailing Address - Country:US
Mailing Address - Phone:718-349-6767
Mailing Address - Fax:718-349-6464
Practice Address - Street 1:45-60 43RD ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:718-349-6767
Practice Address - Fax:718-349-6464
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02384256Medicaid
NY02384256Medicaid