Healthcare Provider Details

I. General information

NPI: 1366042053
Provider Name (Legal Business Name): IMAN M AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 WASHINGTON
HILLSDALE NJ
07642
US

IV. Provider business mailing address

1 CHERBA PL
TOTOWA NJ
07512-1941
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-4250
  • Fax:
Mailing address:
  • Phone: 973-563-8360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04123800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: