Provider Demographics
NPI:1710161955
Name:DASTAGIR, SHADAB SALAM (BPHARM)
Entity Type:Individual
Prefix:
First Name:SHADAB
Middle Name:SALAM
Last Name:DASTAGIR
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5607
Mailing Address - Country:US
Mailing Address - Phone:718-643-2146
Mailing Address - Fax:718-643-4520
Practice Address - Street 1:120 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5607
Practice Address - Country:US
Practice Address - Phone:718-643-2146
Practice Address - Fax:718-643-4520
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist