Healthcare Provider Details

I. General information

NPI: 1093262701
Provider Name (Legal Business Name): MOHAMMED MUNIR AHMED PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2016
Last Update Date: 09/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 W ADDISON ST
CHICAGO IL
60618-4635
US

IV. Provider business mailing address

1 CVS DR MAIL CODE 1090
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 773-604-7681
  • Fax:
Mailing address:
  • Phone: 401-765-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051299631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: