Provider Demographics
NPI:1831541903
Name:ISLAM, MOHAMMED SHAIEFUL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SHAIEFUL
Last Name:ISLAM
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 1:1419 NEWKIRK AVE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6521
Mailing Address - Country:US
Mailing Address - Phone:718-940-1794
Mailing Address - Fax:718-469-6687
Practice Address - Street 1:1419 NEWKIRK AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6521
Practice Address - Country:US
Practice Address - Phone:718-940-1794
Practice Address - Fax:718-469-6687
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist