Provider Demographics
NPI:1912525346
Name:ROSHDI, THOMAS AHMED IBRAHIM (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS AHMED
Middle Name:IBRAHIM
Last Name:ROSHDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1102
Mailing Address - Country:US
Mailing Address - Phone:917-391-3902
Mailing Address - Fax:
Practice Address - Street 1:4313 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5067
Practice Address - Country:US
Practice Address - Phone:201-758-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04012900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI04012900OtherPHARMACIST LICENSE