Provider Demographics
NPI:1003125105
Name:SHAIKH, MOAZZAM AHMED (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOAZZAM
Middle Name:AHMED
Last Name:SHAIKH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SEDWICK RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4452
Mailing Address - Country:US
Mailing Address - Phone:919-544-5807
Mailing Address - Fax:919-572-6694
Practice Address - Street 1:2010 SEDWICK RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4452
Practice Address - Country:US
Practice Address - Phone:919-544-5807
Practice Address - Fax:919-572-6694
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist