Healthcare Provider Details

I. General information

NPI: 1679204598
Provider Name (Legal Business Name): MOHENAD RASOUL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MARKET ST STE 200
WARREN OH
44481-1141
US

IV. Provider business mailing address

111 ELMWOOD DR
HUBBARD OH
44425-1604
US

V. Phone/Fax

Practice location:
  • Phone: 330-785-2054
  • Fax:
Mailing address:
  • Phone: 330-506-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03441990
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: