Healthcare Provider Details

I. General information

NPI: 1760056519
Provider Name (Legal Business Name): AFSHA GOUSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 COLUMBUS AVE
NEW YORK NY
10025-6461
US

IV. Provider business mailing address

741 COLUMBUS AVE
NEW YORK NY
10025-6461
US

V. Phone/Fax

Practice location:
  • Phone: 212-316-0436
  • Fax:
Mailing address:
  • Phone: 212-316-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: