Provider Demographics
NPI:1144643107
Name:MOHAMMADI, SHOHREH
Entity type:Individual
Prefix:
First Name:SHOHREH
Middle Name:
Last Name:MOHAMMADI
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 1:11116 KORMAN DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2045
Mailing Address - Country:US
Mailing Address - Phone:301-318-8019
Mailing Address - Fax:301-983-2046
Practice Address - Street 1:11116 KORMAN DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2045
Practice Address - Country:US
Practice Address - Phone:301-318-8019
Practice Address - Fax:301-983-2046
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist