Healthcare Provider Details

I. General information

NPI: 1063385417
Provider Name (Legal Business Name): ESHMAL MUKHTAR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16812 HILLSIDE AVE
JAMAICA NY
11432-4341
US

IV. Provider business mailing address

16812 HILLSIDE AVE
JAMAICA NY
11432-4341
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-9096
  • Fax:
Mailing address:
  • Phone: 718-206-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: