Provider Demographics
NPI:1124435292
Name:ALI, MOHAMED NAGI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:NAGI
Last Name:ALI
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 1:138 SUDDERTH DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6025
Mailing Address - Country:US
Mailing Address - Phone:575-257-1566
Mailing Address - Fax:
Practice Address - Street 1:138 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6025
Practice Address - Country:US
Practice Address - Phone:575-257-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008115183500000X
COPHA0019892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist