Provider Demographics
NPI:1700939774
Name:REHMAN, FAZALUR (RPH)
Entity type:Individual
Prefix:MR
First Name:FAZALUR
Middle Name:
Last Name:REHMAN
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 1:19 PEBBLE PL
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1513
Mailing Address - Country:US
Mailing Address - Phone:631-462-2090
Mailing Address - Fax:
Practice Address - Street 1:1320-48 STONY BROOK ROAD
Practice Address - Street 2:DUANE-READE,INC
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1513
Practice Address - Country:US
Practice Address - Phone:631-751-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist