Provider Demographics
NPI:1003648387
Name:RAHMAN, MOHAMMED MUSTAFIZUR
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:MUSTAFIZUR
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOHAMMED
Other - Middle Name:MUSTAFIZUR
Other - Last Name:RAHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11443 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-6555
Mailing Address - Country:US
Mailing Address - Phone:313-409-2192
Mailing Address - Fax:
Practice Address - Street 1:812 E SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-8410
Practice Address - Country:US
Practice Address - Phone:517-627-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist