Healthcare Provider Details

I. General information

NPI: 1013193119
Provider Name (Legal Business Name): RIAZ B HUSSAIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 ROUTE 6
MAHOPAC NY
10541-2204
US

IV. Provider business mailing address

159 ROUTE 6
MAHOPAC NY
10541-2204
US

V. Phone/Fax

Practice location:
  • Phone: 845-628-5299
  • Fax: 845-621-0403
Mailing address:
  • Phone: 845-628-5299
  • Fax: 845-621-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number030195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: