Provider Demographics
NPI:1336523398
Name:MOHAMMED, ALI (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 2ND AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6334
Mailing Address - Country:US
Mailing Address - Phone:845-558-9299
Mailing Address - Fax:
Practice Address - Street 1:1976 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6314
Practice Address - Country:US
Practice Address - Phone:212-831-1222
Practice Address - Fax:212-831-1616
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist