Provider Demographics
NPI:1710200126
Name:RAZA, SYED A
Entity Type:Individual
Prefix:MR
First Name:SYED
Middle Name:A
Last Name:RAZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4406
Mailing Address - Country:US
Mailing Address - Phone:718-493-0288
Mailing Address - Fax:718-493-0129
Practice Address - Street 1:509 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4406
Practice Address - Country:US
Practice Address - Phone:718-493-0288
Practice Address - Fax:718-493-0129
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist