Provider Demographics
NPI:1316966211
Name:RAHMAN, FAZALUR
Entity type:Individual
Prefix:MR
First Name:FAZALUR
Middle Name:
Last Name:RAHMAN
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 1:13412 WELBY CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3662
Mailing Address - Country:US
Mailing Address - Phone:804-675-5108
Mailing Address - Fax:804-675-3459
Practice Address - Street 1:13412 WELBY CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-3662
Practice Address - Country:US
Practice Address - Phone:804-675-5108
Practice Address - Fax:804-675-3459
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist