MEDICARE: DR. RAISA NISHAT PHARMD

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	068608	NY

General Provider Information

NPI Number	:	1801552757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAISA NISHAT PHARMD

Provider Business Mailing Address
First Line	:	150 E FAYETTE ST APT 311
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202-1642
Country	:	US
Telephone Number	:	347-421-2543
Fax Number	:

Provider Business Practice Location Address
First Line	:	5380 W TAFT RD
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-3766
Country	:	US
Telephone Number	:	315-458-8555
Fax Number	:

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

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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