Provider Demographics
NPI:1104551514
Name:GAFAR, AHMED M
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:M
Last Name:GAFAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 TORONTO RD APT 16
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-3718
Mailing Address - Country:US
Mailing Address - Phone:929-234-9711
Mailing Address - Fax:
Practice Address - Street 1:7967 CINCINNATI DAYTON RD STE P
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2064
Practice Address - Country:US
Practice Address - Phone:513-755-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist