Individual
DR. SHAFFEEULAH BACCHUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
267 W MERRICK RD, FREEPORT, NY 11520-3346
(718) 938-3274
Mailing address
19650 69TH AVE # 2, FRESH MEADOWS, NY 11365-4033
(718) 454-1607
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
050006
NY
Other
Enumeration date
07/22/2006
Last updated
07/08/2007
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