Provider Demographics
NPI:1841599040
Name:USTA, TOFIQUE NIZAMI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TOFIQUE
Middle Name:NIZAMI
Last Name:USTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2645
Mailing Address - Country:US
Mailing Address - Phone:678-377-5258
Mailing Address - Fax:678-377-0568
Practice Address - Street 1:2075 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2645
Practice Address - Country:US
Practice Address - Phone:678-377-5258
Practice Address - Fax:678-377-0568
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020565183500000X
MAPH26596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist