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General NPI Number Information
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NPI Number | 1174104855
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Entity Type | Individual
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Provider Name | ASSEM MOHAMED
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Gender | Male
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 3300A CENTENNIAL LN
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-3600
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Country | US
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Telephone | 410-739-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 302 OATLEY CT APT 9303
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City | ODENTON
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State | MD
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Zip | 21113-3041
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Country | US
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Telephone | 410-739-8557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 27493
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License Number State | MD
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