Healthcare Provider Details

I. General information

NPI: 1609744390
Provider Name (Legal Business Name): MOHAMED MEKKEYAH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 CRATER LAKE HWY
MEDFORD OR
97504-9259
US

IV. Provider business mailing address

3615 CRATER LAKE HWY
MEDFORD OR
97504-9259
US

V. Phone/Fax

Practice location:
  • Phone: 541-227-5403
  • Fax:
Mailing address:
  • Phone: 541-227-5403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0020795
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: