Provider Demographics
NPI:1952118812
Name:SHAHAB, MOHID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHID
Middle Name:
Last Name:SHAHAB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3419
Mailing Address - Country:US
Mailing Address - Phone:469-438-5753
Mailing Address - Fax:
Practice Address - Street 1:2200 14TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6454
Practice Address - Country:US
Practice Address - Phone:972-423-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist