Provider Demographics
NPI:1558084392
Name:AL WAGEEH, MOHAMMED SALEM ALI
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:SALEM ALI
Last Name:AL WAGEEH
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 1:9060 DYER ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-1406
Mailing Address - Country:US
Mailing Address - Phone:915-751-1753
Mailing Address - Fax:
Practice Address - Street 1:9060 DYER ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1406
Practice Address - Country:US
Practice Address - Phone:915-751-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist