MEDICARE: TAHIR MAHMOOD ALI

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	28RI03634300	NJ

General Provider Information

NPI Number	:	1043625106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHIR MAHMOOD ALI

Provider Business Mailing Address
First Line	:	355 MYRTLE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3216
Country	:	US
Telephone Number	:	718-855-2292
Fax Number	:	718-855-2297

Provider Business Practice Location Address
First Line	:	355 MYRTLE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3216
Country	:	US
Telephone Number	:	718-855-2292
Fax Number	:	718-855-2297

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

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	11/02/2022

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