Provider Demographics
NPI:1992397566
Name:NAWAZ, NAZISH
Entity Type:Individual
Prefix:
First Name:NAZISH
Middle Name:
Last Name:NAWAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5622
Mailing Address - Country:US
Mailing Address - Phone:347-955-3029
Mailing Address - Fax:
Practice Address - Street 1:589 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6020
Practice Address - Country:US
Practice Address - Phone:347-955-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist