Provider Demographics
NPI:1386330843
Name:ISLAM, FAHIM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FAHIM
Middle Name:
Last Name:ISLAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 E 150TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4411
Mailing Address - Country:US
Mailing Address - Phone:516-642-1956
Mailing Address - Fax:
Practice Address - Street 1:799 E 150TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4411
Practice Address - Country:US
Practice Address - Phone:347-271-5275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070193-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist