Provider Demographics
NPI:1366801219
Name:MIRZA, USMAN AHMED (RPH)
Entity type:Individual
Prefix:MR
First Name:USMAN
Middle Name:AHMED
Last Name:MIRZA
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 1:116 GWYNEDD LEA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1921
Mailing Address - Country:US
Mailing Address - Phone:267-736-8877
Mailing Address - Fax:
Practice Address - Street 1:116 GWYNEDD LEA DR
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1921
Practice Address - Country:US
Practice Address - Phone:267-736-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist