Provider Demographics
NPI:1992288294
Name:HAQUE, MOHAMMAD MAIEDUL
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MAIEDUL
Last Name:HAQUE
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 1:8510 160TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1722
Mailing Address - Country:US
Mailing Address - Phone:347-476-9924
Mailing Address - Fax:
Practice Address - Street 1:8510 160TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1722
Practice Address - Country:US
Practice Address - Phone:347-476-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist