MEDICARE: MR. MASHUKUR RAHMAN R.PH

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	038869	NY

General Provider Information

NPI Number	:	1114251485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MASHUKUR RAHMAN R.PH

Provider Business Mailing Address
First Line	:	3420 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1716
Country	:	US
Telephone Number	:	718-348-5000
Fax Number	:	718-348-5005

Provider Business Practice Location Address
First Line	:	3420 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1716
Country	:	US
Telephone Number	:	718-348-5000
Fax Number	:	718-348-5005

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

Provider Enumeration Date	:	09/19/2009
Last Update Date	:	09/19/2009

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