Provider Demographics
NPI:1700942869
Name:HUSSAINI, MOHIB ULLAH (CPTH)
Entity Type:Individual
Prefix:MR
First Name:MOHIB
Middle Name:ULLAH
Last Name:HUSSAINI
Suffix:
Gender:M
Credentials:CPTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8470 129TH ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2810
Mailing Address - Country:US
Mailing Address - Phone:646-417-2879
Mailing Address - Fax:718-495-1321
Practice Address - Street 1:1711 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6601
Practice Address - Country:US
Practice Address - Phone:718-346-7200
Practice Address - Fax:718-495-1321
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270101031159856183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician