Provider Demographics
NPI:1487980025
Name:HUSSEIN, AKTHAM MOHAMMAD (RPH)
Entity type:Individual
Prefix:MR
First Name:AKTHAM
Middle Name:MOHAMMAD
Last Name:HUSSEIN
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 1:70 VAN SICKLEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2739
Mailing Address - Country:US
Mailing Address - Phone:917-226-2157
Mailing Address - Fax:
Practice Address - Street 1:70 VAN SICKLEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2739
Practice Address - Country:US
Practice Address - Phone:917-226-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-01
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist