Provider Demographics
NPI:1316432800
Name:JILANI, ALI AHMAD
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:AHMAD
Last Name:JILANI
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 1:1493 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4809
Mailing Address - Country:US
Mailing Address - Phone:516-754-6795
Mailing Address - Fax:
Practice Address - Street 1:SECOND AVE PHARMACY
Practice Address - Street 2:249 E 115TH ST, NEW YORK
Practice Address - City:NEW YORRK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:201-876-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist