Healthcare Provider Details

I. General information

NPI: 1215269436
Provider Name (Legal Business Name): KAZI FAHMIDA ISLAM PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2010
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 WILLIAMSBRIDGE RD
BRONX NY
10461-1605
US

IV. Provider business mailing address

22 METROPOLITAN OVAL 4B
BRONX NY
10462-6712
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-7569
  • Fax:
Mailing address:
  • Phone: 646-436-2484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054048-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS017838
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: