MEDICARE: MOHAMMAD IRSHAD R.PH

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	032534	NY

General Provider Information

NPI Number	:	1093009284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD IRSHAD R.PH

Provider Business Mailing Address
First Line	:	200 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1336
Country	:	US
Telephone Number	:	718-816-1116
Fax Number	:	718-816-1116

Provider Business Practice Location Address
First Line	:	200 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1336
Country	:	US
Telephone Number	:	718-816-1116
Fax Number	:	718-816-1116

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

Provider Enumeration Date	:	06/05/2011
Last Update Date	:	06/05/2011

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