Provider Demographics
NPI:1851615850
Name:BAMSHAD, JAVID (BS)
Entity Type:Individual
Prefix:
First Name:JAVID
Middle Name:
Last Name:BAMSHAD
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4745
Mailing Address - Country:US
Mailing Address - Phone:718-677-5811
Mailing Address - Fax:718-677-5812
Practice Address - Street 1:3002 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4745
Practice Address - Country:US
Practice Address - Phone:718-677-5811
Practice Address - Fax:718-677-5812
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist