Provider Demographics
NPI:1942524277
Name:GORE, NASIR Y (B PHARM)
Entity Type:Individual
Prefix:
First Name:NASIR
Middle Name:Y
Last Name:GORE
Suffix:
Gender:M
Credentials:B PHARM
Other - Prefix:
Other - First Name:NASIR
Other - Middle Name:YOUSUF
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:553 STEWART AVE
Mailing Address - Street 2:STATEN ISLAND
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6810
Mailing Address - Country:US
Mailing Address - Phone:718-983-1272
Mailing Address - Fax:718-931-6699
Practice Address - Street 1:1663 METROPOLITAN AVE
Practice Address - Street 2:BRONX
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6202
Practice Address - Country:US
Practice Address - Phone:718-931-6699
Practice Address - Fax:718-931-6699
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034360OtherNEW YORK STATE BOARD OF PHARMACY