Provider Demographics
NPI:1962858332
Name:BARRY, MOHAMED (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OLD KINGS RD N
Mailing Address - Street 2:UNIT B
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8226
Mailing Address - Country:US
Mailing Address - Phone:386-447-8944
Mailing Address - Fax:386-447-8940
Practice Address - Street 1:28 OLD KINGS RD N
Practice Address - Street 2:UNIT B
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8226
Practice Address - Country:US
Practice Address - Phone:386-447-8944
Practice Address - Fax:386-447-8940
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist