Healthcare Provider Details

I. General information

NPI: 1780960781
Provider Name (Legal Business Name): MOHAMMAD M MOKHTARY PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 W 33RD CT
HIALEAH FL
33018-5003
US

IV. Provider business mailing address

15130 NW 6TH CT
PEMBROKE PINES FL
33028-1830
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-6395
  • Fax: 305-557-6433
Mailing address:
  • Phone: 954-437-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS28810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: