Basic Information
| Provider Information | |||||||||
| NPI: | 1558648428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOHAMUD | ||||||||
| FirstName: | SULEIMAN | ||||||||
| MiddleName: | SHARIF | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4036 ESTERS RD | ||||||||
| Address2: | APT 2024 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142120299 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2253 CENTRAL BLVD DR | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178689202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2011 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 50615 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.