Healthcare Provider Details

I. General information

NPI: 1568712206
Provider Name (Legal Business Name): MOHAMMAD AWAIS RATTU PHARMD,BCOP,BCPS,CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 12/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL DEPARTMENT OF PHARMACY
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL DEPARTMENT OF PHARMACY
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1509
  • Fax:
Mailing address:
  • Phone: 212-241-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3151792
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number5150832
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057096
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number9103996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: