Healthcare Provider Details

I. General information

NPI: 1699412833
Provider Name (Legal Business Name): FATHIMA SABRIA MOHIDEEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 N PIEDRAS ST # 2
EL PASO TX
79930-4210
US

IV. Provider business mailing address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

V. Phone/Fax

Practice location:
  • Phone: 915-564-6100
  • Fax:
Mailing address:
  • Phone: 915-564-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051304248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: