Healthcare Provider Details

I. General information

NPI: 1245134840
Provider Name (Legal Business Name): MOHAMED AHMED ALI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PLAZA CTR
SECAUCUS NJ
07094-3508
US

IV. Provider business mailing address

119 HASTINGS AVE APT B
RUTHERFORD NJ
07070-1323
US

V. Phone/Fax

Practice location:
  • Phone: 330-780-9119
  • Fax:
Mailing address:
  • Phone: 330-780-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04524300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: