MEDICARE: DR. MOHAMMAD ALI-SHAN JAVID PHARMD

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	RP446505	PA
2	183500000X	Pharmacist	A1-0004312	DE
3	183500000X	Pharmacist	28RI03505300	NJ
4	183500000X	Pharmacist	28RJ04275	NJ
5	183500000X	Pharmacist	RPI006361	PA
6	183500000X	Pharmacist	059473	NY

General Provider Information

NPI Number	:	1447633862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD ALI-SHAN JAVID PHARMD

Provider Business Mailing Address
First Line	:	4511 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2309
Country	:	US
Telephone Number	:	215-457-5555
Fax Number	:	215-457-8340

Provider Business Practice Location Address
First Line	:	4511 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2309
Country	:	US
Telephone Number	:	215-457-5555
Fax Number	:	215-457-8340

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

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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