Provider Demographics
NPI:1871243477
Name:ELMUBARAK, MOHAMED (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:ELMUBARAK
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 1:3945 W GERONIMO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4995
Mailing Address - Country:US
Mailing Address - Phone:714-331-0309
Mailing Address - Fax:
Practice Address - Street 1:18460 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-1108
Practice Address - Country:US
Practice Address - Phone:602-993-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist