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NPI Code Detail

MEDICARE: MR. EJAZ HASAN RPH

MEDICARE: MR. EJAZ HASAN RPH
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
1183500000XPharmacist0202209206VA

General Provider Information

NPI Number : 1780996819
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EJAZ HASAN RPH
Provider Business Mailing Address
First Line : 515 N MAIN ST
Second Line :
City : SUFFOLK
State : VA
Zip : 23434-4426
Country : US
Telephone Number : 757-539-9992
Fax Number : 757-539-0810
Provider Business Practice Location Address
First Line : 3600 TIDEWATER DR
Second Line :
City : NORFOLK
State : VA
Zip : 23509-1436
Country : US
Telephone Number : 757-623-2706
Fax Number : 757-623-5209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2010
Last Update Date : 05/18/2013

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