Provider Demographics
NPI:1184956708
Name:RANGWALA, KUTBUDDIN A
Entity type:Individual
Prefix:
First Name:KUTBUDDIN
Middle Name:A
Last Name:RANGWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 HILLSIDE DR S
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2720
Mailing Address - Country:US
Mailing Address - Phone:516-248-3814
Mailing Address - Fax:
Practice Address - Street 1:1181 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3308
Practice Address - Country:US
Practice Address - Phone:718-277-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist