Provider Demographics
NPI:1780960781
Name:MOKHTARY, MOHAMMAD M (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:M
Last Name:MOKHTARY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15130 NW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1830
Mailing Address - Country:US
Mailing Address - Phone:954-437-9020
Mailing Address - Fax:
Practice Address - Street 1:7605 W 33RD CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5003
Practice Address - Country:US
Practice Address - Phone:305-557-6395
Practice Address - Fax:305-557-6433
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist