Provider Demographics
NPI:1205168002
Name:ISLAM, MUNIR (RPH)
Entity type:Individual
Prefix:MR
First Name:MUNIR
Middle Name:
Last Name:ISLAM
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 1:364 JUNIUS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-7306
Mailing Address - Country:US
Mailing Address - Phone:718-485-4012
Mailing Address - Fax:718-485-5012
Practice Address - Street 1:364 JUNIUS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7306
Practice Address - Country:US
Practice Address - Phone:718-485-4012
Practice Address - Fax:718-485-5012
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042556OtherSUPERVISING PHARMACIST