Provider Demographics
NPI:1285038505
Name:ALENAZI, AHMED (RPH)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ALENAZI
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 1:6500 WHITTLESEY BLVD
Mailing Address - Street 2:APT. #114
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7261
Mailing Address - Country:US
Mailing Address - Phone:603-264-0721
Mailing Address - Fax:
Practice Address - Street 1:710 CENRAL STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-571-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH028185OtherLICENSE NUMBER