Provider Demographics
NPI:1710358627
Name:ABDELGOWAD, MOHAMED M (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:M
Last Name:ABDELGOWAD
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 1:326 GARDEN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1626
Mailing Address - Country:US
Mailing Address - Phone:201-716-2569
Mailing Address - Fax:
Practice Address - Street 1:326 GARDEN ST
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1626
Practice Address - Country:US
Practice Address - Phone:201-716-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213943183500000X
TX60844183500000X
NY067564183500000X
PARP456122183500000X
MI5302413208183500000X
TN44006183500000X
NJ28RI03683400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RJ08589OtherIMMUNIZING PHARMACIST