Provider Demographics
NPI:1154654671
Name:MOHAMED, MAZA A (PHARMD)
Entity type:Individual
Prefix:MS
First Name:MAZA
Middle Name:A
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 RUBY LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3812
Mailing Address - Country:US
Mailing Address - Phone:781-291-9067
Mailing Address - Fax:
Practice Address - Street 1:71 RUBY LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3812
Practice Address - Country:US
Practice Address - Phone:781-291-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist