Individual provider Active NPI

Mohammed Kalam, PHARMD

  • Pharmacist
  • Bridgeport, CT
National Provider Identifier
1417600305
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
15627 Issued in CT
Practice address
850 State St
Bridgeport, CT 06604-3728
Phone
(203) 330-9191
Fax
(203) 330-9193
NPI assigned
Jan 31, 2022
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 15627 CT Primary

Addresses

Primary practice location

850 State St
Bridgeport, CT 06604-3728

Mailing address

1163 Old Colony Rd Unit 19
Wallingford, CT 06492-1792
Phone (203) 583-5786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
15627CTMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Bridgeport Community Pharmacy LLC CurrentSince Feb 1, 2022 Accepting new patients
Doctors Frankel and Hoo, LLC PastSince Feb 1, 2022 Accepting new patients

Locations

192 Fairfield Ave
Bridgeport, CT 06604
Phone (203) 330-9191

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1417600305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1163 OLD COLONY RD UNIT 19",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064921792",
            "telephone_number": "203-583-5786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 STATE ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066043728",
            "telephone_number": "203-330-9191",
            "fax_number": "203-330-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALAM",
        "first_name": "MOHAMMED",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-31",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "15627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.