Provider Demographics
NPI:1942524111
Name:SIDDIQUI, ABDUL A (RPH)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:A
Last Name:SIDDIQUI
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 1:75 HILLSIDE LANE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NEW YORK
Mailing Address - Zip Code:11040
Mailing Address - Country:UM
Mailing Address - Phone:516-225-1252
Mailing Address - Fax:718-462-6479
Practice Address - Street 1:1214 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7047
Practice Address - Country:US
Practice Address - Phone:718-462-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist