Healthcare Provider Details

I. General information

NPI: 1871907279
Provider Name (Legal Business Name): MOHAMED NESREDIN AHMEDIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 WOODCREST DR APT H
AUGUSTA GA
30909-0431
US

IV. Provider business mailing address

2718 WOODCREST DR APT H
AUGUSTA GA
30909-0431
US

V. Phone/Fax

Practice location:
  • Phone: 716-939-0598
  • Fax:
Mailing address:
  • Phone: 716-939-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number027293
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: