Healthcare Provider Details

I. General information

NPI: 1457963142
Provider Name (Legal Business Name): MUHAMMAD DAGHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 08/23/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 47TH AVE
WOODSIDE NY
11377-6037
US

IV. Provider business mailing address

7222 47TH AVE
WOODSIDE NY
11377-6037
US

V. Phone/Fax

Practice location:
  • Phone: 551-229-7466
  • Fax:
Mailing address:
  • Phone: 551-229-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03992900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: