Provider Demographics
NPI:1750677225
Name:HAQUE, FAHEEM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:FAHEEM
Middle Name:
Last Name:HAQUE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GOODE WAY SUIRE 201
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2266
Mailing Address - Country:US
Mailing Address - Phone:757-397-0700
Mailing Address - Fax:757-397-8751
Practice Address - Street 1:301 GOODE WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2266
Practice Address - Country:US
Practice Address - Phone:757-397-0700
Practice Address - Fax:757-397-8751
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209649183500000X
DCPH100000840183500000X
WVRP0007517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist