1245636356 NPI number — DR. MATIUR RAHMAN BHUIYA PHARM D

Table of content: DR. MATIUR RAHMAN BHUIYA PHARM D (NPI 1245636356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245636356 NPI number — DR. MATIUR RAHMAN BHUIYA PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHUIYA
Provider First Name:
MATIUR
Provider Middle Name:
RAHMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245636356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 E EDGEWOOD BLVD APT 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48911-5808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-312-8905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2125 S MISSION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-773-6991
Provider Business Practice Location Address Fax Number:
989-779-8091
Provider Enumeration Date:
11/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  5302040872 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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