Provider Demographics
NPI:1750697603
Name:ISLAM, KAZI SHAFIUL (PHARMD)
Entity type:Individual
Prefix:
First Name:KAZI
Middle Name:SHAFIUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14208 PERSHING CRES
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2022
Mailing Address - Country:US
Mailing Address - Phone:347-730-1653
Mailing Address - Fax:
Practice Address - Street 1:14208 PERSHING CRES
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2022
Practice Address - Country:US
Practice Address - Phone:347-730-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist