Provider Demographics
NPI:1710181656
Name:ALTAF, AHMAD K (RPH)
Entity Type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:K
Last Name:ALTAF
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 1:246 SCANTIC RD
Mailing Address - Street 2:P. O. BOX 0238
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-9735
Mailing Address - Country:US
Mailing Address - Phone:860-627-7008
Mailing Address - Fax:
Practice Address - Street 1:246 SCANTIC ROAD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-9735
Practice Address - Country:US
Practice Address - Phone:860-627-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist