Provider Demographics
NPI:1437667706
Name:MOHAMMEDNUR, RIYAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:RIYAD
Middle Name:
Last Name:MOHAMMEDNUR
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 1:1974 S BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6403
Mailing Address - Country:US
Mailing Address - Phone:323-387-8264
Mailing Address - Fax:
Practice Address - Street 1:20251 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2953
Practice Address - Country:US
Practice Address - Phone:760-946-2430
Practice Address - Fax:760-946-2030
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist