Provider Demographics
NPI:1720595556
Name:RIZVI, NASREEN (SUPRV PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NASREEN
Middle Name:
Last Name:RIZVI
Suffix:
Gender:F
Credentials:SUPRV PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544A SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4506
Mailing Address - Country:US
Mailing Address - Phone:212-795-5004
Mailing Address - Fax:
Practice Address - Street 1:1544A SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4506
Practice Address - Country:US
Practice Address - Phone:212-795-5004
Practice Address - Fax:212-795-3466
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017806Medicaid