Provider Demographics
NPI:1548454663
Name:AHMED MOHAMMED, KHAJA FASIUDDIN
Entity type:Individual
Prefix:
First Name:KHAJA
Middle Name:FASIUDDIN
Last Name:AHMED MOHAMMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7452
Mailing Address - Country:US
Mailing Address - Phone:810-694-3659
Mailing Address - Fax:
Practice Address - Street 1:8410 OXFORD LN
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7452
Practice Address - Country:US
Practice Address - Phone:810-694-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist