Provider Demographics
NPI:1346523479
Name:RIZWAN, MOHAMMAD
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:
Last Name:RIZWAN
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 1:11750 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3159
Mailing Address - Country:US
Mailing Address - Phone:954-344-7361
Mailing Address - Fax:954-344-8320
Practice Address - Street 1:11750 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3159
Practice Address - Country:US
Practice Address - Phone:954-344-7361
Practice Address - Fax:954-344-8320
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist