Healthcare Provider Details

I. General information

NPI: 1619368321
Provider Name (Legal Business Name): HASIB NOOR HOSSAIN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E MOUNT EDEN AVE
BRONX NY
10452-5806
US

IV. Provider business mailing address

35 MINUTEMAN CIR
ORANGEBURG NY
10962-2709
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-3575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060173
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: