Provider Demographics
NPI:1841625886
Name:BAGUM, LUTFUR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUTFUR
Middle Name:
Last Name:BAGUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 MAIN ST
Mailing Address - Street 2:3RD FL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4721
Mailing Address - Country:US
Mailing Address - Phone:718-578-1393
Mailing Address - Fax:
Practice Address - Street 1:519 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2801
Practice Address - Country:US
Practice Address - Phone:718-235-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist