Provider Demographics
NPI:1780964163
Name:LOTFI, MOHAMAD (MOHAMAD LOTFI)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:LOTFI
Suffix:
Gender:M
Credentials:MOHAMAD LOTFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 PLEASANT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7606
Mailing Address - Country:US
Mailing Address - Phone:678-485-4114
Mailing Address - Fax:
Practice Address - Street 1:3794 PLEASANT OAKS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7606
Practice Address - Country:US
Practice Address - Phone:678-485-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE11852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist