Active NPI
Mohamed Elhabit
- Pharmacist
- Virginia, MN
National Provider Identifier
1508488719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 124617
- Practice address
- 1001 13TH St S
Virginia, MN 55792-3254 - Phone
- (612) 512-1559
- NPI assigned
- May 11, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 124617 | MN | Primary |
Addresses
Primary practice location
1001 13TH St S
Virginia, MN 55792-3254
Mailing address
9411 Van Buren St NE
Blaine, MN 55434-2441
Phone (612) 512-1559
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 124617 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589155200000",
"number": "1508488719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9411 VAN BUREN ST NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554342441",
"telephone_number": "612-512-1559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 13TH ST S",
"city": "VIRGINIA",
"state": "MN",
"postal_code": "557923254",
"telephone_number": "612-512-1559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELHABIT",
"first_name": "MOHAMED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-05-11",
"last_updated": "2020-05-11",
"certification_date": "2020-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "124617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.