Provider Demographics
NPI:1811793474
Name:MARFATIA, SHUKAN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SHUKAN
Middle Name:
Last Name:MARFATIA
Suffix:
Gender:
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2414
Mailing Address - Country:US
Mailing Address - Phone:347-866-9187
Mailing Address - Fax:
Practice Address - Street 1:25617 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1617
Practice Address - Country:US
Practice Address - Phone:718-343-5900
Practice Address - Fax:718-343-5901
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist