Provider Demographics
NPI:1811539331
Name:AHAMED, AHAMED A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AHAMED
Middle Name:A
Last Name:AHAMED
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 S UNIVERSITY AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3099
Mailing Address - Country:US
Mailing Address - Phone:319-936-4932
Mailing Address - Fax:
Practice Address - Street 1:609 N SPRING ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2040
Practice Address - Country:US
Practice Address - Phone:920-356-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20121-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist