Provider Demographics
NPI:1346881919
Name:MOHAMMED, SHANG
Entity Type:Individual
Prefix:
First Name:SHANG
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 ARROWCREEK PKWY UNIT 10109
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-5482
Mailing Address - Country:US
Mailing Address - Phone:619-383-4921
Mailing Address - Fax:
Practice Address - Street 1:1630 ROBB DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3516
Practice Address - Country:US
Practice Address - Phone:775-746-6411
Practice Address - Fax:775-746-6416
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist