Provider Demographics
NPI:1245537547
Name:ISMAIL, MOHAMMED A (BPHARM)
Entity type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:A
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1152
Mailing Address - Country:US
Mailing Address - Phone:864-268-7123
Mailing Address - Fax:864-268-7163
Practice Address - Street 1:2700 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1152
Practice Address - Country:US
Practice Address - Phone:864-268-7123
Practice Address - Fax:864-268-7163
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11436183500000X
FLPS0024895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist