Provider Demographics
NPI:1679965750
Name:MOHAMED, DINA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 RIVER RD
Mailing Address - Street 2:APT C5
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1265
Mailing Address - Country:US
Mailing Address - Phone:901-338-5599
Mailing Address - Fax:
Practice Address - Street 1:420 RIVER RD
Practice Address - Street 2:APT C5
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1265
Practice Address - Country:US
Practice Address - Phone:901-338-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03640200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist