Healthcare Provider Details

I. General information

NPI: 1134686173
Provider Name (Legal Business Name): MUHAMMAD USMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 ROCKLAND AVE APT 2
STATEN ISLAND NY
10314-7706
US

IV. Provider business mailing address

928 ROCKLAND AVE APT 2
STATEN ISLAND NY
10314-7706
US

V. Phone/Fax

Practice location:
  • Phone: 347-852-7686
  • Fax:
Mailing address:
  • Phone: 347-852-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: