Provider Demographics
NPI:1083944342
Name:MOHAMMED, ISHMAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ISHMAEL
Middle Name:
Last Name:MOHAMMED
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 1:8911 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2911
Mailing Address - Country:US
Mailing Address - Phone:602-944-9635
Mailing Address - Fax:602-944-7429
Practice Address - Street 1:8911 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2911
Practice Address - Country:US
Practice Address - Phone:602-944-9635
Practice Address - Fax:602-944-7429
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist