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General NPI Number Information
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NPI Number | 1144777608
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Entity Type | Individual
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Provider Name | PETER FAYZ MASOUD RPH
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 393 FRONT STREET WALGREENS PHARMACY THE PHARMACY
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City | HEMPSTEAD
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State | NY
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Zip | 11550-2041
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Country | US
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Telephone | 917-815-3006
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Fax | 718-628-7099
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Provider Business Mailing Address
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Address Line | 6336 60TH PL
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City | RIDGEWOOD
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State | NY
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Zip | 11385-2041
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Country | US
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Telephone | 917-815-3006
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Fax | 718-628-7099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20 062226
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License Number State | NY
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