MEDICARE: MR. SALAH K ISMAIL PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	042599	NY

General Provider Information

NPI Number	:	1033192448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SALAH K ISMAIL PHARMACIST

Provider Business Mailing Address
First Line	:	2795 FRDRK DGLSS BLVD APT 7N
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-3030
Country	:	US
Telephone Number	:	347-792-1545
Fax Number	:	917-409-3179

Provider Business Practice Location Address
First Line	:	2632 7TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-2601
Country	:	US
Telephone Number	:	917-409-3219
Fax Number	:	917-409-3179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	10/15/2021

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