Provider Demographics
NPI:1528317823
Name:AHSAN, MOHAMMAD SHARUKH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SHARUKH
Last Name:AHSAN
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 1:143 RHODES DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3539
Mailing Address - Country:US
Mailing Address - Phone:718-687-6367
Mailing Address - Fax:
Practice Address - Street 1:21939 89TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2518
Practice Address - Country:US
Practice Address - Phone:718-479-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist