Provider Demographics
NPI:1346617958
Name:SLEEM, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:SLEEM
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 1:58 DODD ST
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2615
Mailing Address - Country:US
Mailing Address - Phone:407-620-6720
Mailing Address - Fax:
Practice Address - Street 1:58 DODD ST
Practice Address - Street 2:
Practice Address - City:LAURENCE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08879-2615
Practice Address - Country:US
Practice Address - Phone:407-620-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03721100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist