Provider Demographics
NPI:1568612471
Name:ALI, MOHAMMED (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:PERVAIZ
Other - Middle Name:
Other - Last Name:AKHTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:174 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1322
Mailing Address - Country:US
Mailing Address - Phone:201-909-0971
Mailing Address - Fax:718-733-0128
Practice Address - Street 1:251 E 188TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5301
Practice Address - Country:US
Practice Address - Phone:718-733-6722
Practice Address - Fax:718-733-0128
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist