Provider Demographics
NPI:1417600305
Name:KALAM, MOHAMMED (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:KALAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 OLD COLONY RD UNIT 19
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1792
Mailing Address - Country:US
Mailing Address - Phone:203-583-5786
Mailing Address - Fax:
Practice Address - Street 1:850 STATE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-3728
Practice Address - Country:US
Practice Address - Phone:203-330-9191
Practice Address - Fax:203-330-9193
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist