MEDICARE: MOHAMAD SOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	067673	NY

General Provider Information

NPI Number	:	1093426058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMAD SOW

Provider Business Mailing Address
First Line	:	221 BROAD ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 BROAD ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2057
Country	:	US
Telephone Number	:	718-682-1332
Fax Number	:	718-682-1569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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Directions to “ MOHAMAD SOW ” Practice Location

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