MEDICARE: IDIL MOHAMED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	126843	MN

General Provider Information

NPI Number	:	1932095775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDIL MOHAMED

Provider Business Mailing Address
First Line	:	600 W 79TH ST
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-8301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W 79TH ST
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-8301
Country	:	US
Telephone Number	:	952-737-3821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	06/17/2025

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Directions to “ IDIL MOHAMED ” Practice Location

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