Provider Demographics
NPI:1770805558
Name:SIDDIQUI, YAQOOB MASOOD (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:YAQOOB
Middle Name:MASOOD
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 129TH ST
Mailing Address - Street 2:APT #5N
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2810
Mailing Address - Country:US
Mailing Address - Phone:718-441-8358
Mailing Address - Fax:
Practice Address - Street 1:1236 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221
Practice Address - Country:US
Practice Address - Phone:718-443-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist