Provider Demographics
NPI:1659695468
Name:ELADMA, MOHAMED H (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:H
Last Name:ELADMA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 RUTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3503
Mailing Address - Country:US
Mailing Address - Phone:718-493-4199
Mailing Address - Fax:718-771-8555
Practice Address - Street 1:1081 RUTLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3503
Practice Address - Country:US
Practice Address - Phone:718-493-4199
Practice Address - Fax:718-771-8555
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist