Provider Demographics
NPI:1184160533
Name:HASAN, SYED RAZA (RPH)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:RAZA
Last Name:HASAN
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 1:1561 CLARK DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4376
Mailing Address - Country:US
Mailing Address - Phone:267-809-2396
Mailing Address - Fax:
Practice Address - Street 1:962 E TIOGA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1307
Practice Address - Country:US
Practice Address - Phone:267-809-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist