Provider Demographics
NPI:1659885077
Name:HASSAN, HESHAM HASSAN MABROUK (RPH)
Entity Type:Individual
Prefix:
First Name:HESHAM
Middle Name:HASSAN MABROUK
Last Name:HASSAN
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 1:2321 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4183
Mailing Address - Country:US
Mailing Address - Phone:347-659-4744
Mailing Address - Fax:347-517-4834
Practice Address - Street 1:2321 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:347-808-7727
Practice Address - Fax:347-517-4834
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045693183500000X
DCPH100002750183500000X
NJ28RI03994700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist