Provider Demographics
NPI:1376791780
Name:MOHAMMED, RONALD ALEX (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALEX
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13335 123RD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3216
Mailing Address - Country:US
Mailing Address - Phone:917-548-3349
Mailing Address - Fax:
Practice Address - Street 1:800 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1902
Practice Address - Country:US
Practice Address - Phone:917-548-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046546-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist