=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780784827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASF PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 03/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1018 CONEY ISLAND AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-1313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-434-4000
-----------------------------------------------------
Fax | 718-421-1697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1018 CONEY ISLAND AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-434-0000
-----------------------------------------------------
Fax | 718-421-1697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ASAD MAHMOOD SIDDIQUI
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 718-434-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 028804
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------