Provider Demographics
NPI:1447632203
Name:MOHAMED, MAISON ABDALLA IBRAHIM (RPH)
Entity type:Individual
Prefix:
First Name:MAISON
Middle Name:ABDALLA IBRAHIM
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 VICTORY CIR APT 34
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-5937
Mailing Address - Country:US
Mailing Address - Phone:651-214-8107
Mailing Address - Fax:
Practice Address - Street 1:3934 VICTORY CIR APT 34
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5937
Practice Address - Country:US
Practice Address - Phone:651-214-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-31496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist