Provider Demographics
NPI:1649938077
Name:HANAIF, MOHAMED (PHARMD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:HANAIF
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 1:176 HILL ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-2462
Mailing Address - Country:US
Mailing Address - Phone:203-308-6744
Mailing Address - Fax:
Practice Address - Street 1:176 HILL ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2462
Practice Address - Country:US
Practice Address - Phone:203-308-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist