Provider Demographics
NPI:1376218313
Name:MOHAMED, AHMED (RPH)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:MOHAMED
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 1:10300 4TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5808
Mailing Address - Country:US
Mailing Address - Phone:909-320-2011
Mailing Address - Fax:909-320-2012
Practice Address - Street 1:10300 4TH ST STE 130
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5808
Practice Address - Country:US
Practice Address - Phone:909-320-2011
Practice Address - Fax:909-320-2012
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist