Provider Demographics
NPI:1689136053
Name:MELIKA, SHEREEN THARWAT KOSTANDY (RPH)
Entity Type:Individual
Prefix:
First Name:SHEREEN
Middle Name:THARWAT KOSTANDY
Last Name:MELIKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5518 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3551
Mailing Address - Country:US
Mailing Address - Phone:718-366-6171
Mailing Address - Fax:
Practice Address - Street 1:5518 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3551
Practice Address - Country:US
Practice Address - Phone:718-366-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064916183500000X
NY064916-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist