Provider Demographics
NPI:1790793966
Name:QADIR, MOHAMMAD MOHSIN (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MOHSIN
Last Name:QADIR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:MOHSIN
Other - Last Name:QADIR
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:16 FLAG HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3032
Mailing Address - Country:US
Mailing Address - Phone:914-760-9880
Mailing Address - Fax:212-427-9019
Practice Address - Street 1:1590 MADISON AVE
Practice Address - Street 2:C/O BLISS PHARMACY INC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3816
Practice Address - Country:US
Practice Address - Phone:212-427-4382
Practice Address - Fax:212-427-9019
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist