Provider Demographics
NPI:1467058263
Name:ALISLAMBOULI, MUHAMMAD AHMED (RPH)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:AHMED
Last Name:ALISLAMBOULI
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 1:9 BEEHIVE PL APT D
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3755
Mailing Address - Country:US
Mailing Address - Phone:908-265-5897
Mailing Address - Fax:
Practice Address - Street 1:2560 QUARRY LAKE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3759
Practice Address - Country:US
Practice Address - Phone:410-486-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4424156OtherEMPLOYEE ID