MEDICARE: NIDA SHAHAB PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051352	NY

General Provider Information

NPI Number	:	1083941876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDA SHAHAB PHARM.D

Provider Business Mailing Address
First Line	:	525 EMPIRE BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3121
Country	:	US
Telephone Number	:	718-221-6814
Fax Number	:	718-221-6815

Provider Business Practice Location Address
First Line	:	525 EMPIRE BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3121
Country	:	US
Telephone Number	:	718-221-6814
Fax Number	:	718-221-6815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	11/16/2009

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