Provider Demographics
NPI:1730354846
Name:KAUSAR, NADEEM (RPH)
Entity type:Individual
Prefix:
First Name:NADEEM
Middle Name:
Last Name:KAUSAR
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 1:123 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1503
Mailing Address - Country:US
Mailing Address - Phone:914-738-3333
Mailing Address - Fax:914-738-8607
Practice Address - Street 1:123 5TH AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1503
Practice Address - Country:US
Practice Address - Phone:914-738-3333
Practice Address - Fax:914-738-8607
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02785844Medicaid