Provider Demographics
NPI:1851704985
Name:HUSSAIN, MUSTAFA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:A
Last Name:HUSSAIN
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 1:25 CHIMNEY CT
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2914
Mailing Address - Country:US
Mailing Address - Phone:201-724-9372
Mailing Address - Fax:
Practice Address - Street 1:35 101ST AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3404
Practice Address - Country:US
Practice Address - Phone:718-827-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist