Provider Demographics
NPI:1053693846
Name:AHMAD, ISHFAQ
Entity type:Individual
Prefix:
First Name:ISHFAQ
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ISHFAQ
Other - Middle Name:
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:913 CHRISTANA PL
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7621
Mailing Address - Country:US
Mailing Address - Phone:504-394-0950
Mailing Address - Fax:504-227-9830
Practice Address - Street 1:1600 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3025
Practice Address - Country:US
Practice Address - Phone:504-227-9830
Practice Address - Fax:504-227-9836
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1221147Medicaid