Provider Demographics
NPI:1144523838
Name:MUSHEINESH, FATIMA (RPH)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:MUSHEINESH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9972 66TH RD
Mailing Address - Street 2:#11U
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4460
Mailing Address - Country:US
Mailing Address - Phone:313-283-3156
Mailing Address - Fax:
Practice Address - Street 1:9972 66TH RD
Practice Address - Street 2:11U
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4460
Practice Address - Country:US
Practice Address - Phone:313-283-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055280183500000X
MI5302033812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist