Provider Demographics
NPI:1881310951
Name:BAHLOOL, MOHAMED (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:BAHLOOL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6923 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1501
Mailing Address - Country:US
Mailing Address - Phone:718-333-5193
Mailing Address - Fax:718-333-5194
Practice Address - Street 1:6923 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1501
Practice Address - Country:US
Practice Address - Phone:718-333-5193
Practice Address - Fax:718-333-5194
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist