Provider Demographics
NPI:1386793610
Name:ISLAM, AMIRUL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:AMIRUL
Middle Name:
Last Name:ISLAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3126
Mailing Address - Country:US
Mailing Address - Phone:631-243-4953
Mailing Address - Fax:
Practice Address - Street 1:215 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4426
Practice Address - Country:US
Practice Address - Phone:212-932-6588
Practice Address - Fax:212-662-2011
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist