Healthcare Provider Details

I. General information

NPI: 1245408129
Provider Name (Legal Business Name): SHOAIB W QURESHI R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SUNRISE HWY
PATCHOGUE NY
11772-2254
US

IV. Provider business mailing address

947 JOHN AVE
BAYPORT NY
11705-1008
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-8292
  • Fax:
Mailing address:
  • Phone: 631-363-3129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044451
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier044451
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerRPH. STATE LICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: