Provider Demographics
NPI:1962822429
Name:BALAYAH, MOWLID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MOWLID
Middle Name:
Last Name:BALAYAH
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 1:2711 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1105
Mailing Address - Country:US
Mailing Address - Phone:651-808-3568
Mailing Address - Fax:612-341-2278
Practice Address - Street 1:12727 LEYTE ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6792
Practice Address - Country:US
Practice Address - Phone:651-808-3568
Practice Address - Fax:612-341-2278
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist