Marwan Amin Abdullah, R.PH, CNS
Individual provider Active NPI Nutrition Support Pharmacist · Mount Vernon, NY
NPI 1811213804 · NPPES record last updated Nov 20, 2023
Key facts
- NPI
- 1811213804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nutrition Support Pharmacist 1835N1003X
- License
- I046545-1 (NY)
- Practice address
- 505 Gramatan Ave.
Mount Vernon, NY 10552 - Phone
- (914) 665-5556
- Fax
- (914) 665-5589
- NPI assigned
- Apr 15, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Certified Nurse Specialist, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I046545-1 | NY | MD | Nutrition Support Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iman Pharmacy Inc | Current | Accepting new patients | |
| South Broadway Pharmacy | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Support Pharmacist | 1835N1003X | I046545-1 | NY | Yes |
Addresses
Primary practice location
505 Gramatan Ave.
Mount Vernon, NY 10552
Mailing address
505 Gramatan Ave.
Mount Vernon, NY 10552
Phone (914) 665-5556
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16326 | Other | CBNS | |
| 01914543 | Medicaid | NY |
Other providers in Mount Vernon, NY
- Ab Surgical Supply Co., Inc.
- Jessica Abad
- Abdollah Yamani MD PC
- Abdullah Medical PC
- Mahdi Abdullah
- Naima R Abdus-Salaam
- Stephanie Abel
- Alex Aboagye
- Edina Mensa Aboagye
- Absolute Home Health Care Inc
All providers in Mount Vernon, NY · Nutrition Support Pharmacist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.