Provider Demographics
NPI:1518235068
Name:MOHAMMED, ASJAD KALEEM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ASJAD KALEEM
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 S LITTLE OAK DR
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2193
Mailing Address - Country:US
Mailing Address - Phone:801-808-6563
Mailing Address - Fax:
Practice Address - Street 1:2290 S REDWOOD ROAD
Practice Address - Street 2:OLIVE PHARMACY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119
Practice Address - Country:US
Practice Address - Phone:801-808-6563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48383183500000X
UT6014320-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist