MEDICARE: QASIDA FATIMA YUSSOUF 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	34566	NY

General Provider Information

NPI Number	:	1417074568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QASIDA FATIMA YUSSOUF R.PH

Provider Business Mailing Address
First Line	:	17 LENAPE DR
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-4647
Country	:	US
Telephone Number	:	732-422-6889
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 EMPIRE BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3203
Country	:	US
Telephone Number	:	718-467-0918
Fax Number	:	718-774-3078

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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