Provider Demographics
NPI:1821418070
Name:HASAN, AFM N
Entity Type:Individual
Prefix:
First Name:AFM
Middle Name:N
Last Name:HASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:AFM
Other - Middle Name:N
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1/C BAILY ROAD
Mailing Address - Street 2:
Mailing Address - City:DACCA
Mailing Address - State:DACCA
Mailing Address - Zip Code:41
Mailing Address - Country:BD
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41235 POLLY BUTTE RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-9356
Practice Address - Country:US
Practice Address - Phone:951-929-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist