Provider Demographics
NPI:1558136671
Name:HABIB, MOHAMED (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:HABIB
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 1:387 W BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-5220
Mailing Address - Country:US
Mailing Address - Phone:480-878-8393
Mailing Address - Fax:
Practice Address - Street 1:9900 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-4116
Practice Address - Country:US
Practice Address - Phone:480-878-8393
Practice Address - Fax:480-783-6227
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0267731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist