Provider Demographics
NPI:1457379166
Name:SULTAN, TAHMINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TAHMINA
Middle Name:
Last Name:SULTAN
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 1:19840 EPSOM CRSE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1302
Mailing Address - Country:US
Mailing Address - Phone:718-322-4900
Mailing Address - Fax:718-322-3121
Practice Address - Street 1:12116 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2112
Practice Address - Country:US
Practice Address - Phone:718-322-4900
Practice Address - Fax:718-322-3121
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034961OtherPHARMACIST