Provider Demographics
NPI:1518625748
Name:ALSAMMAN, MOHAMMAD LOUAI (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD LOUAI
Middle Name:
Last Name:ALSAMMAN
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 1:10538 VAN BUREN CIR NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4521
Mailing Address - Country:US
Mailing Address - Phone:612-806-5414
Mailing Address - Fax:
Practice Address - Street 1:10905 ULYSSES ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3827
Practice Address - Country:US
Practice Address - Phone:763-252-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist