Provider Demographics
NPI:1669054110
Name:RAHMAN, ISHRAT (PHARMD)
Entity type:Individual
Prefix:
First Name:ISHRAT
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ACKEN DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2946
Mailing Address - Country:US
Mailing Address - Phone:646-675-3130
Mailing Address - Fax:
Practice Address - Street 1:19 ACKEN DR
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2946
Practice Address - Country:US
Practice Address - Phone:347-993-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056111-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist