Provider Demographics
NPI:1295246239
Name:AFANEH, MALAAK (RPH)
Entity type:Individual
Prefix:
First Name:MALAAK
Middle Name:
Last Name:AFANEH
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 1:75 HYLAN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2081
Mailing Address - Country:US
Mailing Address - Phone:347-596-2246
Mailing Address - Fax:
Practice Address - Street 1:5603 2ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4189
Practice Address - Country:US
Practice Address - Phone:347-599-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063414-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist