Healthcare Provider Details

I. General information

NPI: 1164937553
Provider Name (Legal Business Name): MUHDIIN HAJI AHMED PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 2ND ST SW STE M600B
ROCHESTER MN
55902-1906
US

IV. Provider business mailing address

2015 41ST ST NW APT C06
ROCHESTER MN
55901-1917
US

V. Phone/Fax

Practice location:
  • Phone: 507-255-5731
  • Fax:
Mailing address:
  • Phone: 612-281-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number123425
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: