Provider Demographics
NPI:1518165281
Name:MAHGOUB, AHMED
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:
Last Name:MAHGOUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7584
Mailing Address - Country:US
Mailing Address - Phone:704-655-0916
Mailing Address - Fax:
Practice Address - Street 1:316 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7584
Practice Address - Country:US
Practice Address - Phone:704-655-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0609032Medicaid