Healthcare Provider Details

I. General information

NPI: 1487368163
Provider Name (Legal Business Name): AHMED MUNAF ABDULRAHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

401 MARANS WAY
WOODSTOCK GA
30188-2020
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5000
  • Fax:
Mailing address:
  • Phone: 404-563-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number03442719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: