Healthcare Provider Details

I. General information

NPI: 1679811947
Provider Name (Legal Business Name): DINA MOKHTAR PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W PEACHTREE ST NW
ATLANTA GA
30309-3846
US

IV. Provider business mailing address

950 W PEACHTREE ST NW
ATLANTA GA
30309-3846
US

V. Phone/Fax

Practice location:
  • Phone: 404-253-3547
  • Fax:
Mailing address:
  • Phone: 404-253-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: