Provider Demographics
NPI:1720357296
Name:HAG, AHMED
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:HAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 S COTTON CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5169
Mailing Address - Country:US
Mailing Address - Phone:216-258-6366
Mailing Address - Fax:
Practice Address - Street 1:18591 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1251
Practice Address - Country:US
Practice Address - Phone:602-789-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59228183500000X
OH03127300183500000X
AZS015842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist