MEDICARE: MR. KHAJA MOHIUDDIN MOHAMMED RPH

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	RP0007520	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972893667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KHAJA MOHIUDDIN MOHAMMED RPH

Provider Business Mailing Address
First Line	:	232 SENECA DR
Second Line	:
City	:	MOUNT HOPE
State	:	WV
Zip	:	25880-8833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 MAIN ST
Second Line	:
City	:	MOUNT HOPE
State	:	WV
Zip	:	25880-1105
Country	:	US
Telephone Number	:	304-877-7923
Fax Number	:

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

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	10/23/2012

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