Provider Demographics
NPI:1689212573
Name:FARAH, AHMED (PHARMD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:FARAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CENTRAL ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2841
Mailing Address - Country:US
Mailing Address - Phone:619-379-7598
Mailing Address - Fax:
Practice Address - Street 1:700 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5499
Practice Address - Country:US
Practice Address - Phone:320-231-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR69587183500000X
MN124668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist