Provider Demographics
NPI:1346750536
Name:GYABAAH, MOHAMMED NASIRU
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:NASIRU
Last Name:GYABAAH
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 1:2555 KEYSPORT LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1144
Mailing Address - Country:US
Mailing Address - Phone:513-283-1317
Mailing Address - Fax:
Practice Address - Street 1:437 N WOLF CREEK ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1214
Practice Address - Country:US
Practice Address - Phone:937-833-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist