Ahmedfowz Mohamed Osman, RPH
Individual provider Active NPI Pharmacist · Edian, MN
NPI 1124315841 · NPPES record last updated Jul 1, 2011
Key facts
- NPI
- 1124315841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 118411 (MN)
- Practice address
- 6728 West Trail
Edian, MN 55439-0000 - Phone
- (952) 836-5866
- NPI assigned
- Jul 1, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118411 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tria Pharmacy LLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 118411 | MN | Yes |
Addresses
Primary practice location
6728 West Trail
Edian, MN 55439-0000
Mailing address
6728 West TRL
Edina, MN 55439-1061
Phone (952) 836-5866
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.