Provider Demographics
NPI:1831845627
Name:RAHAMAN, MOSTAFIZUR
Entity type:Individual
Prefix:
First Name:MOSTAFIZUR
Middle Name:
Last Name:RAHAMAN
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 1:1776 1ST ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5271
Mailing Address - Country:US
Mailing Address - Phone:607-205-7089
Mailing Address - Fax:
Practice Address - Street 1:1776 1ST ST APT 3B
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5271
Practice Address - Country:US
Practice Address - Phone:607-205-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068889183500000X
KS1-123042183500000X
NMRP00010146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist