Provider Demographics
NPI:1750043063
Name:MAHMOOD, SANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANNA
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MEADOWS DR APT 102
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3158
Mailing Address - Country:US
Mailing Address - Phone:631-741-6027
Mailing Address - Fax:
Practice Address - Street 1:7325 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3245
Practice Address - Country:US
Practice Address - Phone:317-202-9731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029509A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist