=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780821876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOHAMMAD IMRAN FAROOQI PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2009
-----------------------------------------------------
Last Update Date | 10/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 RIDGEWOOD DR
-----------------------------------------------------
City | BORDENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08505-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-291-7817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 RIDGEWOOD DR
-----------------------------------------------------
City | BORDENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08505-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-291-7817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 053147
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------