Provider Demographics
NPI:1962190884
Name:FAHIM, CHOWDHURY MUSHFIK
Entity type:Individual
Prefix:
First Name:CHOWDHURY
Middle Name:MUSHFIK
Last Name:FAHIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8845 187TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1825
Mailing Address - Country:US
Mailing Address - Phone:347-592-3638
Mailing Address - Fax:
Practice Address - Street 1:18723 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3200
Practice Address - Country:US
Practice Address - Phone:347-644-1886
Practice Address - Fax:347-829-3018
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist