Provider Demographics
NPI:1396920393
Name:HUQ, MUJJAHID (RPH)
Entity type:Individual
Prefix:
First Name:MUJJAHID
Middle Name:
Last Name:HUQ
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 1:1242 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1044
Mailing Address - Country:US
Mailing Address - Phone:347-248-4578
Mailing Address - Fax:718-827-4001
Practice Address - Street 1:1242 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1044
Practice Address - Country:US
Practice Address - Phone:718-886-6645
Practice Address - Fax:718-886-6742
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY49506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01083669Medicaid