Provider Demographics
NPI:1740892470
Name:FAHM, RAPHEW (PHARMD)
Entity type:Individual
Prefix:
First Name:RAPHEW
Middle Name:
Last Name:FAHM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MACDOUGAL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2624
Mailing Address - Country:US
Mailing Address - Phone:917-703-7219
Mailing Address - Fax:
Practice Address - Street 1:1950 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-5511
Practice Address - Country:US
Practice Address - Phone:718-493-0854
Practice Address - Fax:718-493-6512
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist