MEDICARE: AS-SALAM PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	030823	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5802966	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1972881860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AS-SALAM PHARMACY INC

Provider Business Mailing Address
First Line	:	14726 HILLSIDE AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-3329
Country	:	US
Telephone Number	:	718-291-0717
Fax Number	:	718-291-0727

Provider Business Practice Location Address
First Line	:	14726 HILLSIDE AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-3329
Country	:	US
Telephone Number	:	718-291-0717
Fax Number	:	718-291-0727

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	NAZMUL HUDA
Credential	:
Telephone Number	:	718-291-0717

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	01/12/2026

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