Provider Demographics
NPI:1851425078
Name:MOHAMMAD, ABDELWHAB SULIMAN (07271958)
Entity Type:Individual
Prefix:
First Name:ABDELWHAB
Middle Name:SULIMAN
Last Name:MOHAMMAD
Suffix:
Gender:M
Credentials:07271958
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 TERRY RD APT 1201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4989
Mailing Address - Country:US
Mailing Address - Phone:904-333-7051
Mailing Address - Fax:
Practice Address - Street 1:6090 TERRY RD APT 1201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4989
Practice Address - Country:US
Practice Address - Phone:904-333-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist