Provider Demographics
NPI:1831703370
Name:ALI, MAHMOUD M
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:M
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-7404
Mailing Address - Country:US
Mailing Address - Phone:646-642-9681
Mailing Address - Fax:973-396-8919
Practice Address - Street 1:38 MARKET ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-7404
Practice Address - Country:US
Practice Address - Phone:646-642-9681
Practice Address - Fax:973-396-8919
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI040931001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist