Provider Demographics
NPI:1053552174
Name:HOSSAIN, MOHAMMED MOSHAREF (RPH)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:MOSHAREF
Last Name:HOSSAIN
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 1:487 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3811
Mailing Address - Country:US
Mailing Address - Phone:718-972-8300
Mailing Address - Fax:718-972-8301
Practice Address - Street 1:487 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3811
Practice Address - Country:US
Practice Address - Phone:718-972-8300
Practice Address - Fax:718-972-8301
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052773OtherPHARMACIST