Provider Demographics
NPI:1871907279
Name:AHMEDIN, MOHAMED NESREDIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:NESREDIN
Last Name:AHMEDIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 WOODCREST DR APT H
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0431
Mailing Address - Country:US
Mailing Address - Phone:716-939-0598
Mailing Address - Fax:
Practice Address - Street 1:2718 WOODCREST DR APT H
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0431
Practice Address - Country:US
Practice Address - Phone:716-939-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0272931835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy