Healthcare Provider Details

I. General information

NPI: 1043840317
Provider Name (Legal Business Name): ASHIQ UDDIN AHMED RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 CASTOR AVE
PHILADELPHIA PA
19149-2792
US

IV. Provider business mailing address

2607 WELSH RD APT J102
PHILADELPHIA PA
19114-3330
US

V. Phone/Fax

Practice location:
  • Phone: 215-535-2800
  • Fax:
Mailing address:
  • Phone: 215-906-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452541
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: