Provider Demographics
NPI:1659831105
Name:IQBAL, SHAMSA
Entity Type:Individual
Prefix:
First Name:SHAMSA
Middle Name:
Last Name:IQBAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 77TH ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1216
Mailing Address - Country:US
Mailing Address - Phone:646-520-8282
Mailing Address - Fax:
Practice Address - Street 1:3287 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4005
Practice Address - Country:US
Practice Address - Phone:718-278-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist