Provider Demographics
NPI:1740619022
Name:MOUSTAFA, LILA AHMED (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LILA
Middle Name:AHMED
Last Name:MOUSTAFA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LILA
Other - Middle Name:
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:26 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3321
Mailing Address - Country:US
Mailing Address - Phone:631-833-1498
Mailing Address - Fax:
Practice Address - Street 1:500 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5020
Practice Address - Country:US
Practice Address - Phone:631-855-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297248183500000X
NY058254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist