Provider Demographics
NPI:1134387095
Name:HAQUE, SYED MOHAMMAD ZIAUL (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SYED
Middle Name:MOHAMMAD ZIAUL
Last Name:HAQUE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2328
Mailing Address - Country:US
Mailing Address - Phone:631-253-4552
Mailing Address - Fax:631-253-4557
Practice Address - Street 1:323 MERRITT AVE
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2328
Practice Address - Country:US
Practice Address - Phone:631-253-4552
Practice Address - Fax:631-253-4557
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02078119Medicaid