Provider Demographics
NPI:1194331801
Name:NASSER, MOHAMED (PHARMD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:NASSER
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 1:48923 TUSCAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4885
Mailing Address - Country:US
Mailing Address - Phone:313-717-8187
Mailing Address - Fax:
Practice Address - Street 1:48923 TUSCAN HILLS DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4885
Practice Address - Country:US
Practice Address - Phone:313-717-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist