Provider Demographics
NPI:1710157417
Name:DARHAN, AMALL M
Entity Type:Individual
Prefix:
First Name:AMALL
Middle Name:M
Last Name:DARHAN
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 1:475 NEW LOTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-6414
Mailing Address - Country:US
Mailing Address - Phone:718-272-4566
Mailing Address - Fax:
Practice Address - Street 1:475 NEW LOTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6414
Practice Address - Country:US
Practice Address - Phone:718-272-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0407065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist