Healthcare Provider Details

I. General information

NPI: 1366061327
Provider Name (Legal Business Name): SHAYDUL HASSAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 MADISON AVE
NEW YORK NY
10029-6542
US

IV. Provider business mailing address

2220 NEWBOLD AVE
BRONX NY
10462-5108
US

V. Phone/Fax

Practice location:
  • Phone: 212-824-8824
  • Fax:
Mailing address:
  • Phone: 347-266-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number062520
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: