Provider Demographics
NPI:1700665064
Name:NOUR, MOHAMED A (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:NOUR
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 20TH AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5770
Mailing Address - Country:US
Mailing Address - Phone:347-233-8543
Mailing Address - Fax:
Practice Address - Street 1:2474 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3842
Practice Address - Country:US
Practice Address - Phone:716-897-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist