Provider Demographics
NPI:1639774847
Name:MOHAMMED, DEEQ (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:DEEQ
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 LAGOON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2059
Mailing Address - Country:US
Mailing Address - Phone:612-825-1992
Mailing Address - Fax:612-825-1996
Practice Address - Street 1:1104 LAGOON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2059
Practice Address - Country:US
Practice Address - Phone:612-825-1992
Practice Address - Fax:612-825-1996
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist