Provider Demographics
NPI:1922641638
Name:MIR, HASIBULLAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:HASIBULLAH
Middle Name:
Last Name:MIR
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 1:7522 PARSONS BLVD APT B3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1014
Mailing Address - Country:US
Mailing Address - Phone:347-613-3677
Mailing Address - Fax:
Practice Address - Street 1:7522 PARSONS BLVD APT B3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1014
Practice Address - Country:US
Practice Address - Phone:347-613-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY065794Medicaid