Provider Demographics
NPI:1366756041
Name:TANVEIR, MOHAMMAD WAQAS
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:WAQAS
Last Name:TANVEIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25405 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1613
Mailing Address - Country:US
Mailing Address - Phone:718-347-7312
Mailing Address - Fax:
Practice Address - Street 1:25405 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1613
Practice Address - Country:US
Practice Address - Phone:718-347-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist