Healthcare Provider Details

I. General information

NPI: 1558543652
Provider Name (Legal Business Name): PEYMAN AHDOUT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PENINSULA BLVD
HEMPSTEAD NY
11550-4913
US

IV. Provider business mailing address

17 NIRVANA AVE
GREAT NECK NY
11023-1150
US

V. Phone/Fax

Practice location:
  • Phone: 516-489-1942
  • Fax:
Mailing address:
  • Phone: 516-829-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: