=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841911484
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IFRAH ANSARI PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2022
-----------------------------------------------------
Last Update Date | 09/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16570 BAISLEY BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11434-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-528-2246
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 ALBON RD
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-2636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-710-4477
-----------------------------------------------------
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 | I069446-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------