Provider Demographics
NPI:1255322186
Name:SIDDIQUI, MOHAMMAD ASLAM (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:ASLAM
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 KNAPP AVE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1141
Mailing Address - Country:US
Mailing Address - Phone:606-783-6740
Mailing Address - Fax:606-783-6693
Practice Address - Street 1:222 MEDICAL CIRCLE
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351
Practice Address - Country:US
Practice Address - Phone:606-783-6740
Practice Address - Fax:606-783-6693
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist