Provider Demographics
NPI:1669659223
Name:TAWA, MOHAMED SHAKEER IBRAHIM (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED SHAKEER
Middle Name:IBRAHIM
Last Name:TAWA
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 1:440 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1620
Mailing Address - Country:US
Mailing Address - Phone:718-980-3486
Mailing Address - Fax:718-980-4801
Practice Address - Street 1:440 9TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1620
Practice Address - Country:US
Practice Address - Phone:718-980-3486
Practice Address - Fax:718-980-4801
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist