Provider Demographics
NPI:1356415194
Name:AFANEH, MOHAMMAD I (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:I
Last Name:AFANEH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:MOE
Other - Middle Name:
Other - Last Name:AFANEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:7160 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3811
Mailing Address - Country:US
Mailing Address - Phone:561-714-0373
Mailing Address - Fax:
Practice Address - Street 1:7160 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3811
Practice Address - Country:US
Practice Address - Phone:561-714-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS392181835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS39218OtherPHARMACIST
FL8425OtherORTHOTIC FITTER