Provider Demographics
NPI:1699219592
Name:UDDIN, ISLAH (RPH)
Entity Type:Individual
Prefix:
First Name:ISLAH
Middle Name:
Last Name:UDDIN
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 1:2130 1ST AVE
Mailing Address - Street 2:APT 216
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3321
Mailing Address - Country:US
Mailing Address - Phone:929-431-7345
Mailing Address - Fax:
Practice Address - Street 1:2130 1ST AVE
Practice Address - Street 2:APT 216
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3321
Practice Address - Country:US
Practice Address - Phone:929-431-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist