Provider Demographics
NPI:1881359552
Name:JALLOH, MOHAMED ALI JR
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ALI
Last Name:JALLOH
Suffix:JR
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 1:205 COLONNADE DR
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-7676
Mailing Address - Country:US
Mailing Address - Phone:704-907-2405
Mailing Address - Fax:
Practice Address - Street 1:3703 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3001
Practice Address - Country:US
Practice Address - Phone:336-540-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30131OtherNORTH CAROLINA BOARD OF PHARMACY LICENSE NUMBER
1217630OtherNATIONAL ASSOCIATION OF BOARDS OF PHARMACY