Provider Demographics
NPI:1871280271
Name:MOHAMED, AHMED ALTYEB ALSIDDEG SAID (RPH)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:ALTYEB ALSIDDEG SAID
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 DORRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7022
Mailing Address - Country:US
Mailing Address - Phone:312-843-0237
Mailing Address - Fax:
Practice Address - Street 1:12410 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7642
Practice Address - Country:US
Practice Address - Phone:804-364-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist