Provider Demographics
NPI:1255428330
Name:UDDIN, MOHAMMAD ATAHER (MS RPH)
Entity type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:ATAHER
Last Name:UDDIN
Suffix:
Gender:M
Credentials:MS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16901 GOTHIC DR
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2041
Mailing Address - Country:US
Mailing Address - Phone:917-209-1131
Mailing Address - Fax:718-565-6041
Practice Address - Street 1:7523 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5612
Practice Address - Country:US
Practice Address - Phone:718-565-8667
Practice Address - Fax:718-565-6041
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01328270Medicaid