Provider Demographics
NPI:1700161692
Name:ALI, SYED M (RPH)
Entity Type:Individual
Prefix:MR
First Name:SYED
Middle Name:M
Last Name:ALI
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 1:11902 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2422
Mailing Address - Country:US
Mailing Address - Phone:718-529-9503
Mailing Address - Fax:718-529-9509
Practice Address - Street 1:11902 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2422
Practice Address - Country:US
Practice Address - Phone:718-529-9503
Practice Address - Fax:718-529-9509
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39800183500000X
NY2056202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist