Provider Demographics
NPI:1407179831
Name:ISLAM, MOHAMMED AMINUL (RPH)
Entity type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:AMINUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SHETLAND CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-8303
Mailing Address - Country:US
Mailing Address - Phone:845-827-5006
Mailing Address - Fax:
Practice Address - Street 1:7 SHETLAND CIR
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-8303
Practice Address - Country:US
Practice Address - Phone:845-827-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist