Provider Demographics
NPI:1043791254
Name:MOHAMED, HEBA MOHAMED (RPH)
Entity Type:Individual
Prefix:
First Name:HEBA
Middle Name:MOHAMED
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 85TH ST APT B1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3129
Mailing Address - Country:US
Mailing Address - Phone:347-988-1696
Mailing Address - Fax:
Practice Address - Street 1:556 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2275
Practice Address - Country:US
Practice Address - Phone:347-889-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist