Provider Demographics
NPI:1376704437
Name:MOHAMED, KUREISHA BANU (PHARMD)
Entity Type:Individual
Prefix:
First Name:KUREISHA
Middle Name:BANU
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 VIA MARISOL APT 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5081
Mailing Address - Country:US
Mailing Address - Phone:310-963-4124
Mailing Address - Fax:
Practice Address - Street 1:3961 VIA MARISOL APT 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-5081
Practice Address - Country:US
Practice Address - Phone:310-963-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-21
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist