Provider Demographics
NPI:1750150389
Name:MOUISSAT, MOHAMED SHERMAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:SHERMAN
Last Name:MOUISSAT
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 1:11980 TELEGRAPH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6087
Mailing Address - Country:US
Mailing Address - Phone:562-270-5374
Mailing Address - Fax:562-860-7183
Practice Address - Street 1:11980 TELEGRAPH RD STE 102
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6087
Practice Address - Country:US
Practice Address - Phone:562-270-5374
Practice Address - Fax:562-860-7183
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018722183500000X
AL21226183500000X
ARPD11895183500000X
NE14035183500000X
CARPH54881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist