Healthcare Provider Details

I. General information

NPI: 1730297458
Provider Name (Legal Business Name): S R AHMAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W MAIN ST
WATERLOO NY
13165-1329
US

IV. Provider business mailing address

12 WEST MAIN STREET
WATERLOO NY
13165
US

V. Phone/Fax

Practice location:
  • Phone: 315-539-9323
  • Fax: 315-539-4146
Mailing address:
  • Phone: 315-539-9323
  • Fax: 315-539-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number020371
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020371
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number020371
License Number StateNY

VIII. Authorized Official

Name: MR. SARDAR RAFIQ AHMAD
Title or Position: PRESIDENT
Credential: RPH
Phone: 315-539-9323