Provider Demographics
NPI:1740570852
Name:MOHSEN, AYMAN (RPH)
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:
Last Name:MOHSEN
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 1:1207 E GRAND AVE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2419
Mailing Address - Country:US
Mailing Address - Phone:805-489-1830
Mailing Address - Fax:805-489-4039
Practice Address - Street 1:1207 E GRAND AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2419
Practice Address - Country:US
Practice Address - Phone:805-489-1830
Practice Address - Fax:805-489-4039
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH63603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMEDICAIDMedicaid