Provider Demographics
NPI:1699083907
Name:FARD, ABE (RPH)
Entity type:Individual
Prefix:MR
First Name:ABE
Middle Name:
Last Name:FARD
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 1:6 CRESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1602
Mailing Address - Country:US
Mailing Address - Phone:908-720-2252
Mailing Address - Fax:
Practice Address - Street 1:6 CRESTWOOD PL
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1602
Practice Address - Country:US
Practice Address - Phone:908-720-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist