Healthcare Provider Details

I. General information

NPI: 1508760281
Provider Name (Legal Business Name): S R AHMAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W MAIN ST
WATERLOO NY
13165-1329
US

IV. Provider business mailing address

12 W MAIN ST
WATERLOO NY
13165-1329
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: HEE RYOUNG CHOI
Title or Position: PHARMACY OPS
Credential:
Phone: 914-650-4124