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General NPI Number Information
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NPI Number | 1316432800
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Entity Type | Individual
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Provider Name | ALI AHMAD JILANI
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | SECOND AVE PHARMACY 249 E 115TH ST, NEW YORK
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City | NEW YORRK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 201-876-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1493 SHERWOOD DR
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City | EAST MEADOW
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State | NY
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Zip | 11554-4809
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Country | US
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Telephone | 516-754-6795
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Fax |
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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 | 063992
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License Number State | NY
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