MEDICARE: MOHAMED A SALOUM RPH

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	28RI02987900	NJ

General Provider Information

NPI Number	:	1811200041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED A SALOUM RPH

Provider Business Mailing Address
First Line	:	4238 HARBOR BEACH BLVD
Second Line	:
City	:	BRIGANTINE
State	:	NJ
Zip	:	08203-0820
Country	:	US
Telephone Number	:	609-266-8999
Fax Number	:	609-266-2430

Provider Business Practice Location Address
First Line	:	4238 HARBOR BEACH BLVD
Second Line	:
City	:	BRIGANTINE
State	:	NJ
Zip	:	08203-1361
Country	:	US
Telephone Number	:	609-266-8999
Fax Number	:	609-266-2430

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	07/16/2010

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