Provider Demographics
NPI:1851997258
Name:MOHAMED-NOUR, ELWALEED E
Entity Type:Individual
Prefix:
First Name:ELWALEED
Middle Name:E
Last Name:MOHAMED-NOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ELWALEED
Other - Middle Name:E
Other - Last Name:MOHAMED-NOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1190 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4832
Mailing Address - Country:US
Mailing Address - Phone:904-751-4346
Mailing Address - Fax:
Practice Address - Street 1:1190 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4832
Practice Address - Country:US
Practice Address - Phone:904-751-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist