Provider Demographics
NPI:1548775042
Name:MOHAMMED, BAN JAWAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:BAN
Middle Name:JAWAD
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1190
Mailing Address - Country:US
Mailing Address - Phone:402-438-4381
Mailing Address - Fax:
Practice Address - Street 1:4700 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1190
Practice Address - Country:US
Practice Address - Phone:402-438-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist