Provider Demographics
NPI:1730218975
Name:MIR, SHAFQAT A (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SHAFQAT
Middle Name:A
Last Name:MIR
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 1:58 CHERRY ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4818
Mailing Address - Country:US
Mailing Address - Phone:201-938-0853
Mailing Address - Fax:
Practice Address - Street 1:1631 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5050
Practice Address - Country:US
Practice Address - Phone:718-938-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01467330Medicaid