MEDICARE: MUSTAFA A. HUSSAIN 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	059135	NY

General Provider Information

NPI Number	:	1851704985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUSTAFA A. HUSSAIN PHARMD

Provider Business Mailing Address
First Line	:	25 CHIMNEY CT
Second Line	:
City	:	LAURENCE HARBOR
State	:	NJ
Zip	:	08879-2914
Country	:	US
Telephone Number	:	201-724-9372
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 101ST AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3404
Country	:	US
Telephone Number	:	718-827-4000
Fax Number	:

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

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/05/2014

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