Provider Demographics
NPI:1730784737
Name:CHOWDHURY, AZMETA ISLAM
Entity type:Individual
Prefix:DR
First Name:AZMETA
Middle Name:ISLAM
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17802 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3145
Mailing Address - Country:US
Mailing Address - Phone:718-291-7373
Mailing Address - Fax:
Practice Address - Street 1:17802 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3145
Practice Address - Country:US
Practice Address - Phone:718-291-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist