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General NPI Number Information
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NPI Number | 1780960781
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Entity Type | Individual
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Provider Name | MOHAMMAD M MOKHTARY PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 7605 W 33RD CT
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City | HIALEAH
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State | FL
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Zip | 33018-5003
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Country | US
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Telephone | 305-557-6395
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Fax | 305-557-6433
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Provider Business Mailing Address
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Address Line | 15130 NW 6TH CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1830
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Country | US
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Telephone | 954-437-9020
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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 | PS28810
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License Number State | FL
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