Healthcare Provider Details

I. General information

NPI: 1700296779
Provider Name (Legal Business Name): ABDUL Q NAZ RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 CONEY ISLAND AVE
BROOKLYN NY
11230-2303
US

IV. Provider business mailing address

1056 CONEY ISLAND AVE
BROOKLYN NY
11230-2303
US

V. Phone/Fax

Practice location:
  • Phone: 718-421-5533
  • Fax: 718-421-7440
Mailing address:
  • Phone: 718-421-5533
  • Fax: 718-421-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03605500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: