Provider Demographics
NPI:1396590527
Name:SUHAIL, COCANUT MOHAMMED (PHARMD)
Entity type:Individual
Prefix:
First Name:COCANUT
Middle Name:MOHAMMED
Last Name:SUHAIL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3164 ROUNDWAY DOWN LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8527
Mailing Address - Country:US
Mailing Address - Phone:502-648-7632
Mailing Address - Fax:
Practice Address - Street 1:200 N HURSTBOURNE PKWY STE 174
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5138
Practice Address - Country:US
Practice Address - Phone:844-552-9669
Practice Address - Fax:502-690-4466
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYI15156183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician