MEDICARE: MR. NISAR REHMAN RPH

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	038486	NY

General Provider Information

NPI Number	:	1659434942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NISAR REHMAN RPH

Provider Business Mailing Address
First Line	:	110 2ND ST
Second Line	:
City	:	GARDEN CITY PARK
State	:	NY
Zip	:	11040-4408
Country	:	US
Telephone Number	:	516-294-4951
Fax Number	:	718-843-3628

Provider Business Practice Location Address
First Line	:	11901 ROCKAWAY BLVD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-2421
Country	:	US
Telephone Number	:	718-843-8000
Fax Number	:	718-843-3628

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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