Provider Demographics
NPI:1003096470
Name:MEKKI -ELAMIN, MOHAMED ELAMIN
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ELAMIN
Last Name:MEKKI -ELAMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CHURCHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4624
Mailing Address - Country:US
Mailing Address - Phone:585-662-5247
Mailing Address - Fax:
Practice Address - Street 1:437 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-1639
Practice Address - Country:US
Practice Address - Phone:585-647-2784
Practice Address - Fax:585-647-6673
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist