Active NPI
Elwalid Mohamed
- Pharmacist
- Eagle, ID
National Provider Identifier
1669225025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P10924
- Practice address
- 250 S Eagle Rd
Eagle, ID 83616-5906 - Phone
- (208) 939-9850
- NPI assigned
- Apr 8, 2024
- Sex
- Male
- Sole proprietor
- No
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 | P10924 | ID | Primary |
Addresses
Primary practice location
250 S Eagle Rd
Eagle, ID 83616-5906
Mailing address
6281 S Aspiration Ave
Meridian, ID 83642-1058
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 |
|---|---|---|---|
| P10924 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1669225025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6281 S ASPIRATION AVE",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 S EAGLE RD",
"city": "EAGLE",
"state": "ID",
"postal_code": "836165906",
"telephone_number": "208-939-9850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMED",
"first_name": "ELWALID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-08",
"last_updated": "2024-04-08",
"certification_date": "2024-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P10924",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.