Healthcare Provider Details

I. General information

NPI: 1477462059
Provider Name (Legal Business Name): ABDULLAH MOHAMMED EZZELDINE RAGHEB RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 FLATBUSH AVE
BROOKLYN NY
11217-2820
US

IV. Provider business mailing address

2156 PROSPECT AVE
EAST MEADOW NY
11554-1943
US

V. Phone/Fax

Practice location:
  • Phone: 929-298-0369
  • Fax:
Mailing address:
  • Phone: 917-940-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074438
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: