Provider Demographics
NPI:1861681546
Name:AHMED, MUSTAQUE (RPH)
Entity Type:Individual
Prefix:
First Name:MUSTAQUE
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16807 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2627
Mailing Address - Country:US
Mailing Address - Phone:917-225-6284
Mailing Address - Fax:
Practice Address - Street 1:9101 37TH AVE
Practice Address - Street 2:OPTIMA PHARMACY
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7919
Practice Address - Country:US
Practice Address - Phone:718-206-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist