Provider Demographics
NPI:1710106505
Name:RAHMAN, MOHAMMAD ASABUR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ASABUR
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 CAPTAINS GATE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5811
Mailing Address - Country:US
Mailing Address - Phone:718-377-1680
Mailing Address - Fax:718-951-7520
Practice Address - Street 1:1901 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6201
Practice Address - Country:US
Practice Address - Phone:718-377-1680
Practice Address - Fax:718-951-7520
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist