Provider Demographics
NPI:1295272276
Name:MAHMOUD, NASER
Entity type:Individual
Prefix:
First Name:NASER
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 KENNEDY DR
Mailing Address - Street 2:UNIT 110
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3325
Mailing Address - Country:US
Mailing Address - Phone:617-921-0571
Mailing Address - Fax:
Practice Address - Street 1:244 KENNEDY DR
Practice Address - Street 2:UNIT 110
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3325
Practice Address - Country:US
Practice Address - Phone:617-921-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH21048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist