Provider Demographics
NPI:1285394635
Name:MOHAMEDELHASSAN, ALA
Entity type:Individual
Prefix:
First Name:ALA
Middle Name:
Last Name:MOHAMEDELHASSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2793
Mailing Address - Country:US
Mailing Address - Phone:843-553-3185
Mailing Address - Fax:843-553-8337
Practice Address - Street 1:2915 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-2859
Practice Address - Country:US
Practice Address - Phone:252-649-6054
Practice Address - Fax:252-649-6054
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist