Provider Demographics
NPI:1134393176
Name:RASOOL, ALIYA A (RPH)
Entity type:Individual
Prefix:MS
First Name:ALIYA
Middle Name:A
Last Name:RASOOL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 17 GRAND CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HILLCREST
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1808
Mailing Address - Country:US
Mailing Address - Phone:718-591-0978
Mailing Address - Fax:
Practice Address - Street 1:164 17 GRAND CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:HILLCREST
Practice Address - State:NY
Practice Address - Zip Code:11432-1808
Practice Address - Country:US
Practice Address - Phone:718-591-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY45701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist