Provider Demographics
NPI:1063793545
Name:AW-DAHIR, MOHAMED AHMED (RPH)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:AHMED
Last Name:AW-DAHIR
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 1:7098 159TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5130
Mailing Address - Country:US
Mailing Address - Phone:925-200-5866
Mailing Address - Fax:651-686-1072
Practice Address - Street 1:2010 CLIFF RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2313
Practice Address - Country:US
Practice Address - Phone:651-686-6940
Practice Address - Fax:651-686-1072
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist