Healthcare Provider Details

I. General information

NPI: 1144679309
Provider Name (Legal Business Name): ASHFAQ AHMED R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 102
ALBUQUERQUE NM
87106-4923
US

IV. Provider business mailing address

2316 ACADEMIC PL SE
ALBUQUERQUE NM
87106-4071
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-6195
  • Fax: 505-243-0785
Mailing address:
  • Phone: 248-707-9512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010085
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: