Provider Demographics
NPI:1740685239
Name:HAQUE, AHSANUL
Entity type:Individual
Prefix:
First Name:AHSANUL
Middle Name:
Last Name:HAQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 HAMPTON POINT DR APT B
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4881
Mailing Address - Country:US
Mailing Address - Phone:804-405-0087
Mailing Address - Fax:
Practice Address - Street 1:3335 HAMPTON POINT DR APT B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4881
Practice Address - Country:US
Practice Address - Phone:804-405-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist