Healthcare Provider Details

I. General information

NPI: 1023709375
Provider Name (Legal Business Name): MOHAMMED AHMED HUSSAIN ANSARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5624 BALTIMORE NATIONAL PIKE
BALTIMORE MD
21228-1418
US

IV. Provider business mailing address

5624 BALTIMORE NATIONAL PIKE
BALTIMORE MD
21228-1418
US

V. Phone/Fax

Practice location:
  • Phone: 410-719-7608
  • Fax: 410-719-0400
Mailing address:
  • Phone: 410-719-7608
  • Fax: 410-719-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT28051
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: