Provider Demographics
NPI:1952625451
Name:HABIB, MARY MOHEB (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MOHEB
Last Name:HABIB
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 1:19 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1951
Mailing Address - Country:US
Mailing Address - Phone:518-783-4027
Mailing Address - Fax:
Practice Address - Street 1:19 CITATION DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1951
Practice Address - Country:US
Practice Address - Phone:518-783-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist