Provider Demographics
NPI:1790079457
Name:ASHRAF, MOHAMMAD I (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:ASHRAF
Suffix:I
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3204
Mailing Address - Country:US
Mailing Address - Phone:718-923-1600
Mailing Address - Fax:718-923-1609
Practice Address - Street 1:598 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3204
Practice Address - Country:US
Practice Address - Phone:718-923-1600
Practice Address - Fax:718-923-1609
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207078Medicaid