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General NPI Number Information
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NPI Number | 1508468919
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Entity Type | Individual
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Provider Name | MOHAMMED ALI MEMON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 3355 S 27TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53215-4303
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Country | US
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Telephone | 414-383-1522
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Fax |
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Provider Business Mailing Address
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Address Line | 4963 S 55TH ST APT 103
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City | GREENFIELD
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State | WI
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Zip | 53220-5312
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Country | US
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Telephone | 773-512-1505
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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 | 18146-40
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License Number State | WI
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