Provider Demographics
NPI:1023664349
Name:ISLAM, RUSHDAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RUSHDAN
Middle Name:
Last Name:ISLAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 GLOUCESTER CT
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5301
Mailing Address - Country:US
Mailing Address - Phone:516-849-8015
Mailing Address - Fax:
Practice Address - Street 1:3800 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2455
Practice Address - Country:US
Practice Address - Phone:718-239-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist