Provider Demographics
NPI:1386447407
Name:MOHAMED, MAZEN MOHAMED YEHIA
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:MOHAMED YEHIA
Last Name:MOHAMED
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3032
Mailing Address - Country:US
Mailing Address - Phone:570-906-4177
Mailing Address - Fax:
Practice Address - Street 1:217 S BLAKELY ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2203
Practice Address - Country:US
Practice Address - Phone:570-343-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP459238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist