Provider Demographics
NPI:1508116039
Name:ISMAIL, MOHAMED (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:ISMAIL
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 1:2942 E NISBET CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2103
Mailing Address - Country:US
Mailing Address - Phone:602-214-2333
Mailing Address - Fax:
Practice Address - Street 1:2858 N PINAL AVE
Practice Address - Street 2:
Practice Address - City:CASAGRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-9999
Practice Address - Country:US
Practice Address - Phone:520-426-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist