Provider Demographics
NPI:1205164423
Name:KASEB, MOHAMED O (RPH)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:O
Last Name:KASEB
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 1:2623 EDGEFIELD LAKES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-6007
Mailing Address - Country:US
Mailing Address - Phone:248-562-8172
Mailing Address - Fax:
Practice Address - Street 1:8098 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2902
Practice Address - Country:US
Practice Address - Phone:713-781-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-29
Last Update Date:2009-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46943183500000X
MI5302033413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist